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Traditional lipid measures are just as good at predicting the development of coronary heart disease as concentrations of apolipoproteins (apo), and testing for the newer measures is not needed, according to a prospective cohort study of more than 3300 American adultsadults.
The role of low density lipoprotein cholesterol (LDL-C) in the pathogenesis of atherosclerotic disease is well established, as is the use of LDL-C, high density lipoprotein cholesterol (HDL-C), and total cholesterol in assessing the risk of coronary heart disease. Reports had suggested that apo B and apo A-I measurements might be better predictors of risk, because apo B concentrations may better reflect the plasma concentration of atherogenic particles, and the study aimed to test this idea.
After a median follow-up of 15 years, 291 participants had developed coronary heart disease. Multivariate modelling adjusting for non-lipid risk factors showed the ratio of apo B to apo A-I predicted coronary heart disease (hazard ratio per SD increment 1.39, 95% CI 1.23 to 1.58 in men and 1.40, 1.16 to 1.67 in women), but no better than the ratio of total cholesterol to HDL-C (hazard ratio 1.39, 1.22 to 1.58 in men and 1.39, 1.17 to 1.66 in women) or the ratio of LDL-C to HDL-C (1.35, 1.18 to 1.54 in men and 1.36, 1.14 to 1.63 in women).