Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jun 11;83(23):2262-2273.
doi: 10.1016/j.jacc.2024.03.423.

Excess Apolipoprotein B and Cardiovascular Risk in Women and Men

Camilla Ditlev Lindhardt Johannesen  1 , Anne Langsted  1 , Børge Grønne Nordestgaard  1 , Martin Bødtker Mortensen  2
Affiliations
Free article

Excess Apolipoprotein B and Cardiovascular Risk in Women and Men

Camilla Ditlev Lindhardt Johannesen et al. J Am Coll Cardiol. .
Free article

Abstract

Background: Low-density lipoprotein cholesterol (LDL-C) and apolipoprotein B (apoB) are highly correlated measures of atherogenic lipoproteins.

Objectives: The study investigators hypothesized that excess apoB is associated with an increased risk of myocardial infarction (MI), atherosclerotic cardiovascular disease (ASCVD), and all-cause mortality.

Methods: The study included 53,484 women and 41,624 men not taking statins from the Copenhagen General Population Study. Associations of excess apoB with the risk of MI, ASCVD, and all-cause mortality were estimated by Cox proportional hazards regressions with 95% CIs. Excess apoB was defined as measured levels of apoB minus expected levels of apoB from LDL-C alone; expected levels were defined by linear regressions of LDL-C levels vs apoB levels in individuals with triglycerides ≤1 mmol/L (89 mg/dL).

Results: During a median follow-up of 9.6 years, 2,048 MIs, 4,282 ASCVD events, and 8,873 deaths occurred. There was a dose-dependent association between excess apoB and the risk of MI and ASCVD in both women and men, as well as an association with the risk of all-cause mortality in women. For ASCVD in women compared with those with excess apoB <11 mg/dL, the multivariable adjusted HR was 1.08 (95% CI: 0.97-1.21) for excess apoB 11 to 25 mg/dL, 1.30 (95% CI: 1.14-1.48) for 26 to 45 mg/dL, 1.34 (95% CI: 1.14-1.58) for 46 to 100 mg/dL, and 1.75 (95% CI: 1.08-2.83) for excess apoB >100 mg/dL. Corresponding HRs in men were 1.14 (95% CI: 1.02-1.26), 1.41 (95% CI: 1.26-1.57), 1.41 (95% CI: 1.25-1.60), and 1.52 (95% CI: 1.13-2.05), respectively. Results were robust across the entire LDL-C spectrum.

Conclusions: Excess apoB (ie, the value of apoB above that contributed by LDL-C levels alone) is associated dose-dependently with an increased risk of MI and ASCVD in women and men. This finding demonstrates that apoB provides important predictive value beyond LDL-C across the entire LDL-C spectrum.

Keywords: LDL cholesterol; apolipoprotein B; atherosclerosis; cardiovascular risk.

PubMed Disclaimer

Conflict of interest statement

Funding Support and Author Disclosures The study was supported by Herlev and Gentofte Hospital, the Capital Region of Denmark, Overlæge Johan Boserup og Lise Boserups Legat, Aase og Ejnar Danielsens Fond, and by Beckett-Fonden. Dr Nordestgaard has served as a consultant or speaker for AstraZeneca, Sanofi, Regeneron, Ionis, Amgen, Kowa, Denka, Amarin, Novartis, Novo Nordisk, Silence Therapeutics, Abbott, Ultragenyx, Mankind, Esperion, USV, Lilly, Arrowhead, and Marea. Dr Mortensen has served as a consultant or speaker for AstraZeneca, Sanofi, Amgen, Amarin, and Novo Nordisk. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

LinkOut - more resources