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1
Healthy Heart Program, St. Paul’s Hospital and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, V6Z 1Y6 Canada.
2
Department of Medicine, Royal Victoria Hospital, McGill University, Quebec, H3A 1A1 Canada.
aAddress correspondence to this author at: St. Paul’s Hospital Healthy Heart Program, #180-1081 Burrard St., Vancouver, British Columbia, V6Z 1Y6 Canada. E-mail jifr{at}interchange.ubc.ca.
Background: Current clinical guidelines require that five indices (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and the total/HDL cholesterol ratio) be measured or calculated to assess the lipid-related risk of vascular disease. All five are also targets of therapy and therefore all must be measured initially and at follow-up. Considerable evidence indicates that apolipoprotein B (apo B) is a better index of reaching or not reaching treatment targets than total or LDL cholesterol.
Methods: The objective of this study was to examine whether measurement of a single marker (apo B) led to the same categorization of risk as the traditional five indices (lipid profile). If both apo B and lipid profile indicated that the patient was either within or outside their respective treatment targets, the indices were considered concordant. If not, the indices were considered discordant. Concordance/discordance was examined in 215 patients at their first and last clinic visit.
Results: Concordance was high in both higher (88% at the first and 92% at the last clinic visit) and lower (76% at the first and 78% at the last clinic visit) risk groups at both the initial and final visits. Discordance was virtually restricted to the group with hypertriglyceridemia with normal concentrations of apo B, a group in which little independent evidence points to any substantially increased risk of vascular disease.
Conclusions: These data raise the possibility that at least for high risk patients treated with statins, follow-up could be simplified and expenses reduced if only apo B were measured. They also raise the possibility that outcome might be improved if the therapeutic algorithm were simplified.
The following articles in journals at HighWire Press have cited this article:
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  J. R. Burnett and G. F. Watts Estimating LDL ApoB: Infomania or Clinical Advance? Clin. Chem., May 1, 2008; 54(5): 782 - 784. [Full Text] [PDF]
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 M. A. Denke Weighing in Before the Fight: Low-Density Lipoprotein Cholesterol and Non-High-Density Lipoprotein Cholesterol Versus Apolipoprotein B as the Best Predictor for Coronary Heart Disease and the Best Measure of Therapy Circulation, November 29, 2005; 112(22): 3368 - 3370. [Full Text] [PDF]
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 P. M Ridker, N. Rifai, N. R. Cook, G. Bradwin, and J. E. Buring Non-HDL Cholesterol, Apolipoproteins A-I and B100, Standard Lipid Measures, Lipid Ratios, and CRP as Risk Factors for Cardiovascular Disease in Women JAMA, July 20, 2005; 294(3): 326 - 333. [Abstract] [Full Text] [PDF]
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 A. M. Wagner, A. Perez, E. Zapico, and J. Ordonez-Llanos Non-HDL Cholesterol and Apolipoprotein B in the Dyslipidemic Classification of Type 2 Diabetic Patients Diabetes Care, July 1, 2003; 26(7): 2048 - 2051. [Abstract] [Full Text] [PDF]
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 A. F. Ayyobi, S. H. McGladdery, M. J. McNeely, M. A. Austin, A. G. Motulsky, and J. D. Brunzell Small, Dense LDL and Elevated Apolipoprotein B Are the Common Characteristics for the Three Major Lipid Phenotypes of Familial Combined Hyperlipidemia Arterioscler. Thromb. Vasc. Biol., July 1, 2003; 23(7): 1289 - 1294. [Abstract] [Full Text] [PDF]
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P. N. Durrington Can Measurement of Apolipoprotein B Replace the Lipid Profile in the Follow-up of Patients with Lipoprotein Disorders? Clin. Chem., March 1, 2002; 48(3): 401 - 402. [Full Text] [PDF]
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