| Title: | Impact of LDL-C and apolipoprotein B level discordance and associated lipoprotein particle alterations on cardiovascular outcomes in a large primary prevention population |
| Journal: | European Journal of Preventive Cardiology |
| Published: | 24 Nov 2025 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/41284723/ |
| DOI: | https://doi.org/10.1093/eurjpc/zwaf750 |
| URL: | https://academic.oup.com/eurjpc/advance-article-pdf/doi/10.1093/eurjpc/zwaf750/65492534/zwaf750.pdf |
Publication 18799
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Abstract
AIMS: Emerging evidence suggests that ApoB outperforms LDL-C in predicting cardiovascular risk, especially in cases of discordance with the two. However, the specific type and composition of lipoprotein particles in this situation remain unclear.</p>
METHODS: 375,544 individuals were enrolled from the UK Biobank without baseline cardiovascular disease, not on lipid-lowering therapy, and with available lipid nuclear magnetic resonance (NMR) data. Based on whether the absolute difference in baseline percentile of LDL-C and ApoB level was over 10 units, participants were categorized into concordant, discordantly high ApoB, and discordantly low ApoB group. The primary endpoint was major adverse cardiovascular events (MACE).</p>
RESULTS: Cox regression analysis showed the risk of MACE was increased in the discordantly high ApoB group (HR, 1.11; 95% CI, 1.06-1.15) and reduced in the discordantly low ApoB group (HR, 0.87; 95% CI, 0.83-0.93). Similar trends were observed in the NMR data. Compared to the other two groups, the discordantly high ApoB group exhibited the highest concentrations of VLDL-C, VLDL-CE, and VLDL particles. However, the CE content per LDL, IDL, and VLDL particle was lower in this group. Mediation analysis showed that VLDL particles and triglycerides mediated 25.5% and 26.6% of the MACE risk, respectively, in the discordantly high ApoB group (both P < 0.001).</p>
CONCLUSION: ApoB is a more comprehensive marker of cardiovascular risk than LDL-C. The higher cardiovascular risk in discordantly high ApoB individuals was partly mediated by VLDL; however, no conclusive evidence indicated that VLDL provides additional prognostic value beyond triglyceride measurements alone.</p>
9 Authors
- Yuan Du
- Wenbo Ding
- Zixiang Ye
- Yanjun Song
- Lijian Gao
- Ying Gao
- Weixian Yang
- Kefei Dou
- Yuanlin Guo
1 Application
| Application ID | Title |
|---|---|
| 97155 | Association of the life pattern with the risk of myocardial infarction (MI) in people without standard modifiable cardiovascular risk factors (SMuRFs) |
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