Nicholas A. Marston, MD, MPH Thrombolysis in Myocardial Infarction (TIMI) Study Group Brigham and Women’s Hospital Harvard Medical School Boston, Massachusetts

Study Finds Risk of MI Best Captured By Number of Apolipoprotein B Lipoproteins

MedicalResearch.com Interview with:

Nicholas A. Marston, MD, MPH Thrombolysis in Myocardial Infarction (TIMI) Study Group Brigham and Women’s Hospital Harvard Medical School Boston, Massachusetts

Dr. Marston

Nicholas A. Marston, MD, MPH
Thrombolysis in Myocardial Infarction (TIMI) Study Group
Brigham and Women’s Hospital
Harvard Medical School
Boston, Massachusetts

MedicalResearch.com: What is the background for this study?

Response: There has been recent debate about how much of lipid-associated cardiovascular risk is from LDL cholesterol versus triglycerides. However, genetic studies suggest that apolipoprotein B is actually the primary driver of atherosclerotic risk.

Since there is exactly one apoB lipoprotein on each lipid particle (LDL, IDL, VLDL), its measurement is a surrgate for the total number of apoB-containing lipoproteins.

So in this study, we asked the question: Do common measures of cholesterol concentration, triglyceride concentration, or their ratio carry predictive value for cardiovascular risk beyond the number of apo-B containing lipoproteins?

MedicalResearch.com: What are the main findings? 

Response: In this prospective cohort analysis in a large primary prevention cohort and large secondary prevention cohort, apoB was the only lipid parameter significantly associated with risk of MI after adjustment. There was also no relationship between the ratio of lipoprotein types and MI, demonstrating that for a given number of apoB-containing lipoproteins, one type does not carry greater risk. 

MedicalResearch.com: What should readers take away from your report?

Response: The main take-away is that risk for MI is best captured by the number of apoB-containing lipoproteins, and is independent from lipid content (cholesterol or TG) or type of lipoprotein (LDL or TG-rich). Where available, measurement of apoB should be considered along with the standard lipid panel.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: As the accompanying editorial points out, this study should help end the debate as to which lipid parameter is the most associated with cardiovascular risk. This is especially relevant as novel lipid-lowering therapies focus on both LDL-C and TG lowering, which would be best quantified using apoB as the primary lipid endpoint.

MedicalResearch.com: Is there anything else you would like to add?

Response: It is worth noting that the European Society of Cardiology recognizes the value of apoB measurement and has incorporated it into their dyslipidemia guidelines. The 2018 US cholesterol guidelines had not yet endorsed apoB.

Citation: 

Marston NA, Giugliano RP, Melloni GEM, et al. Association of Apolipoprotein B–Containing Lipoproteins and Risk of Myocardial Infarction in Individuals With and Without Atherosclerosis: Distinguishing Between Particle Concentration, Type, and Content. JAMA Cardiol. Published online November 13, 2021. doi:10.1001/jamacardio.2021.5083

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