Non-fasting apolipoprotein B100/apolipoprotein A1 ratio as risk marker of myocardial infarction
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It is still widely debated whether apolipoproteins are better markers for coronary heart disease than lipids and lipoproteins. The aim of this large standardized case-control study was to compare apolipoproteins and cholesterol as indices for risk of acute myocardial infarction. To this end, 12,461 cases of acute myocardial infarction and 14,637 age- and sex-matched controls were studied in 52 countries. Odds ratios (OR) and 95% CI as well as population-attributable risks (PAR) were calculated for each measure and for each ethnic group by comparing the top four quintiles with the lowest quintile. These analyses revealed that the non-fasting apolipoprotein B100 (ApoB)/apolipoprotein A-1 (ApoA1) ratio, an index of circulating proatherogenic and antiatherogenic lipoproteins, had the highest PAR (54%) whereas the PAR for the LDL cholesterol/HDL cholesterol ratio (37%) and for the total cholesterol/HDL cholesterol ratio (32%) were significantly lower. No differences were noted between ethnic groups, sexes or ages. In conclusion, the ApoB/ApoA1 ratio was superior to any of the cholesterol-based ratios for estimating the risk of acute myocardial infarction across ethnic groups, sexes and ages. According to the authors, this ratio should thus be introduced into worldwide clinical practice, especially since measuring ApoB and ApoA1 is standardised, simple, and does not require fasting samples.
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