Lipid Levels and Cardiovascular Risk

Apolipoprotein B (Apo B) may be the best predictor of heart disease risk.

An article by Clare Pain in the current issue of Australian Doctor has reported on the results of a recent multi-national study on lipid levels and cardiovascular risk. The study published in the Journal of the American Medical Association found that levels of apolipoprotein B (Apo B) may be a better predictor of coronary heart disease risk than either low-density lipoprotein cholestrol (LDL-C) or triglyceride levels.

The study looked at genetic data from 654 783 participants. The key finding was that triglyceride-lowering variants in the lipoprotein lipase gene and low-density lipoprotein cholestrol (LDL-C) -lowering variants inthe LDL receptor gene were each associated with similar lower risk of coronary heart disease per 10-mg/dL lower level of apolipoprotein B (Apo-B) -containing lipoproteins.

There are two main lipoprotein particles that contain cholestrol. LDL particles contain cholestrol and one molecule of apoB. VLDL particle also contain one molecule of apo B and both triglycerides and some cholestrol. Currently the emphasis has been on LDL cholestrol being the "bad" cholestrol causing increased cardiovascular (CVD) risk. The results of this study provide evidence that very low-density lipoprotein (VLDL) particles that carry triglycerides are as atherogenic as low-density lipoproteins containing cholestrol.

Since both VLDL and LDL each contain one molecule of apo B then an apo B test is measured of the total number of "bad" lipid particles ie. LDL+VLDL and this single test may be the best measure of a person's CVD risk.

Sydney lipid expert and chemical pathologist Professor David Sullivan is quoted in the article as saying: " Apo B particles that carry either cholestrol or triglyceride seem to be able to cause damage and therefore we should concentrate on measurements like Apo B in order to work out what sort of a problem our patients might face."

Most Australian pathology labs provide Apo B testing but it is not currently subsidised on the Medical Benefits Schedule. However, an application is being considered by the Medical Services Advisory Committee and this study will assist them in their deliberations.

Further Information
JAMA abstract

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