Apolipoprotein B and cardiovascular risk in asymptomatic patients: need for systematic evaluation?

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background The involvement of apolipoprotein B (apoB) in atherogeneis is well known because of its role in the metabolism of lipids. Elevated levels of apoB have been found not only to be correlated with clinical atherosclerosis, but also with sub-clinical forms. Cardiovascular risk can be estimated based on clinical risk scores. However, the main limitation of these risk score models is to estimate only traditional risk factors and not other important factors such as apoB. Purpose To assess the interactive effects of apoB in asymptomatic patients, and its link to cardiovascular risk. Methods This prospective observational study included 811 asymptomatic participants. According to the median apoB value (set at 130 mg/ dl) the study population was divided into two groups as follows: group 1 – 713 patients with low apoB values and group 2 – 98 patients with high apoB. Also, for each patient personal data, such as family history of premature cardiovascular disease, smoker status, personal history of heart failure or atherosclerotis were obtained. Regarding the subclinical atherosclerosis the carotid thickness of intima-media was measured. Results Patients with high apoB are more frequent males (p=0.008) with a mean age of 57.6 ± 11.9 years old (p<0.0001) and smokers (p=0.01). The apoB level was not higher in patients with known atherosclerosis or with traditional risk factors such as diabetes melitus, history of stroke, myocardial infarction, or hypertension. Although, subclinical atherosclerosis, expressed by the presence of carotid plaques is more frequent found in patients with elevated apoB levels (p=0.0001). A higher total cholesterol (p<0.0001), triglycerides (p<0.0001) and LDL-cholesterol levels (p<0.0001) were identified in patients from group 2 compared with those form group 1. Moreover, the uric acid was observed to be correlated with the apoB serum level (5.2 ±1.5 vs. 6.2 ±1.7, p=0.001). The risk of diabetes melitus was also found to be higher in group 2 compared with group 1, expressed by the glycosylate haemoglobin (5.6 ± 0.7 vs 5.9 ± 1.1, p<0.0001). Conclusions Apolipoprotein B level is correlated with subclinical atherosclerosis and worse outcomes expressed by a higher lipid profile and risk of diabetes melitus development. These findings highlighted that the determination of the apoB is therefore mandatory for a better stratification of cardiovascular risks in primary prevention of atherosclerosis.