Eddy Edson
Well-Known Member
- Relationship to Diabetes
- Type 2
A new JAMA paper causing some noise on cardiology twitter: https://jamanetwork.com/journals/jamacardiology/article-abstract/2786333
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Question Are common measures of cholesterol concentration, triglyceride concentration, or their ratio associated with cardiovascular risk beyond the number of apolipoprotein B (apoB)–containing lipoproteins?
Findings In this cohort analysis, apoB was the only lipid parameter significantly associated with risk of myocardial infarction after adjustment. No association was found between the ratio of lipoprotein types and myocardial infarction, indicating that, for a given number of apoB-containing lipoproteins, one type may not be associated with increased risk.
Meaning Risk of myocardial infarction may best be captured by the number of apoB-containing lipoproteins, independent from lipid content (cholesterol or triglyceride) or type of lipoprotein (low-density lipoprotein or triglyceride-rich).
Accompanied by invited commentary: https://jamanetwork.com/journals/jamacardiology/fullarticle/2786334
In 1979, Avogaro et al1 reported that apolipoprotein B (apoB) was a more accurate marker of the risk of a myocardial infarction than total cholesterol. In 1980, Sniderman et al2 reported that low-density lipoprotein (LDL) apoB was a more accurate marker of the risk of angiographic coronary lesions than LDL cholesterol (LDL-C). They inferred that the mass of cholesterol per apoB particle could vary and they speculated that the number of apoB particles mattered more than the cholesterol they contained because it was the particle that entered and was deposited within the arterial wall.2 Since then, there has been considerable debate whether apoB, LDL-C, or non–high-density lipoprotein cholesterol (non-HDL-C) should be the primary measure of apoB lipoprotein-related risk. The debate is over. In this issue, Marston and colleagues3 supply decisive evidence from a large, prospective observational study, UK Biobank, and 2 clinical trials, FOURIER (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk) and IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial), that apoB should be the primary marker to assess the cardiovascular risk due to the apoB lipoproteins.
So the latest piece of evidence that the important thing is the number of apoB particles, not the amount or type of lipids.
As I understand it, these particles get into the artery wall and become the key driver for the development of atherosclerosis, an action not dependent on the lipids associated with them.
According to the authors, there is a strong correlation between thye number of apoB particles and the amount of LDL-C and, more so, the amount of non-HDL cholesterol (because the apoB particles are associated with all of LDL-C, VLDL and triglycerides). So these measures continue to be clinically useful for assessing risk. But adding in an apoB measure to the standard lipid panel would increase precision and sometimes make a difference in guiding management.
In common with every major recent study I have looked at, there is absolutely no mention of the UK-style HDL ratio metric, which seems to have no place in this understanding of things.
.
Question Are common measures of cholesterol concentration, triglyceride concentration, or their ratio associated with cardiovascular risk beyond the number of apolipoprotein B (apoB)–containing lipoproteins?
Findings In this cohort analysis, apoB was the only lipid parameter significantly associated with risk of myocardial infarction after adjustment. No association was found between the ratio of lipoprotein types and myocardial infarction, indicating that, for a given number of apoB-containing lipoproteins, one type may not be associated with increased risk.
Meaning Risk of myocardial infarction may best be captured by the number of apoB-containing lipoproteins, independent from lipid content (cholesterol or triglyceride) or type of lipoprotein (low-density lipoprotein or triglyceride-rich).
Accompanied by invited commentary: https://jamanetwork.com/journals/jamacardiology/fullarticle/2786334
In 1979, Avogaro et al1 reported that apolipoprotein B (apoB) was a more accurate marker of the risk of a myocardial infarction than total cholesterol. In 1980, Sniderman et al2 reported that low-density lipoprotein (LDL) apoB was a more accurate marker of the risk of angiographic coronary lesions than LDL cholesterol (LDL-C). They inferred that the mass of cholesterol per apoB particle could vary and they speculated that the number of apoB particles mattered more than the cholesterol they contained because it was the particle that entered and was deposited within the arterial wall.2 Since then, there has been considerable debate whether apoB, LDL-C, or non–high-density lipoprotein cholesterol (non-HDL-C) should be the primary measure of apoB lipoprotein-related risk. The debate is over. In this issue, Marston and colleagues3 supply decisive evidence from a large, prospective observational study, UK Biobank, and 2 clinical trials, FOURIER (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk) and IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial), that apoB should be the primary marker to assess the cardiovascular risk due to the apoB lipoproteins.
So the latest piece of evidence that the important thing is the number of apoB particles, not the amount or type of lipids.
As I understand it, these particles get into the artery wall and become the key driver for the development of atherosclerosis, an action not dependent on the lipids associated with them.
According to the authors, there is a strong correlation between thye number of apoB particles and the amount of LDL-C and, more so, the amount of non-HDL cholesterol (because the apoB particles are associated with all of LDL-C, VLDL and triglycerides). So these measures continue to be clinically useful for assessing risk. But adding in an apoB measure to the standard lipid panel would increase precision and sometimes make a difference in guiding management.
In common with every major recent study I have looked at, there is absolutely no mention of the UK-style HDL ratio metric, which seems to have no place in this understanding of things.
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