| Title: | Risk-weighted apoB: a novel summary metric outperforming traditional lipid biomarkers in predicting coronary heart disease |
| Journal: | European Heart Journal |
| Published: | 22 Jan 2026 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/41568673/ |
| DOI: | https://doi.org/10.1093/eurheartj/ehaf1124 |
Publication 18501
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Abstract
BACKGROUND AND AIMS: LDL-C and non-HDL-C do not fully capture coronary heart disease (CHD) risk attributed to all apoB-containing lipoproteins. Use of apolipoprotein B (apoB) as a marker of total atherogenic particle number improves risk prediction, but risk may still be underestimated when triglyceride-rich lipoproteins (TRL/remnants) and lipoprotein(a) [Lp(a)] are elevated. The aim was to formulate a new metric-risk-weighted apoB (RW-apoB)-designed to capture risk from LDL, TRL/remnants, and Lp(a) in a single number.</p>
METHODS: Based on previously published estimates of the relative atherogenicity of LDL, TRL/remnant, and Lp(a) particles, RW-apoB was developed (using UK Biobank data) as an atherogenicity-weighted apoB-sum calculated as: RW-apoB = 11.65×TG(mmol/L) + 0.215×lipoprotein(a)(nmol/L) + 0.736×apoB(mg/dL).</p>
RESULTS: Assigning RW-apoB to individuals substantially reclassified their risk status. Compared with ranking by measured apoB, 52% of individuals were up- or down-ranked by ≥10 percentiles. About one-third of those in the top RW-apoB quintile-with elevated TRL and Lp(a) and a CHD event rate of 5.4%-were misclassified as lower risk by apoB. Conversely, individuals in the top measured apoB quintile but with low TRL and Lp(a) had a lower event rate (3.9%) and were correctly down-ranked. RW-apoB improved risk prediction, significantly increasing Harrell's C-index relative to apoB (P < .0001). In statin-treated subjects, RW-apoB was potentially a better index of residual risk. RW-apoB consistently outperformed apoB as a risk predictor in Cox models across the UK Biobank and three other large population cohorts.</p>
CONCLUSIONS: RW-apoB represents not only particle number but also accounts for the higher atherogenicity of TRL and Lp(a). It offers clinically meaningful improvements in CHD risk stratification.</p>
13 Authors
- Michaela B Rehman
- Elias Björnson
- Martin Adiels
- Jakub Morze
- Göran Bergström
- Anders Gummesson
- David Erlinge
- Tove Fall
- Ljubica Matic
- Stefan Söderberg
- Carl Johan Östgren
- Chris J Packard
- Jan Borén
1 Application
| Application ID | Title |
|---|---|
| 82018 | Improved biomarkers of cardiovascular disease |
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