CAN APOLIPOPROTEIN B LEVELS PREDICT CARDIOVASCULAR RISK POST ACUTE CORONARY SYNDROME?

Abstract

Apolipoprotein B (ApoB) is a strong predictor of CV events in patients at high-risk for coronary artery disease. Whether ApoB is a viable prognostic marker in patients with acute coronary syndrome is unknown. We evaluated whether ApoB level predicted time to development of major adverse cardiovascular events in men and women with ACS aged 55 years or less at one year. We also compared its predictive utility in menopausal and perimenopausal women given hormone replacement therapy. We used data from a prospective cohort study of 1015 patients (30% women) aged 55 years or less, hospitalized for ACS and enrolled in the GENESIS PRAXY (GENdEr and Sex DetermInantS of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary SYndrome) study (January 2009-September 2012). Baseline ApoB levels was measured during hospitalization for ACS. Patients were followed for one year for the composite of recurrent ACS, death, need for recurrent revascularization, or re-hospitalization for cardiac cause. 38% had ApoB levels <0.89g/L, 33% had levels 0.90-1.1g/L and 29% with levels >1.2g/L. Patients with the lowest ApoB levels were more likely to be women, have a history of unstable angina, previous MI and previous PCI and to be prescribed statins compared with higher ApoB levels. There was no statistically significant difference in the risk of composite CV outcome and increasing ApoB level (age/sex adjusted HR 0.49, 95%CI 0.22-1.08). In menopausal women, higher ApoB levels were associated with a reduction in the composite CV outcome (age/sex adjusted HR 0.24, 95%CI 0.06-0.92). ApoB does not predict CV outcomes post-MI in our population. Interestingly, higher ApoB levels showed trends towards better outcomes, especially in menopausal women. Future studies should focus on the role of ApoB as a predictor of CV outcomes in the non-acute setting.