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Review
. 2024 Jul 2;150(1):62-79.
doi: 10.1161/CIRCULATIONAHA.124.068885. Epub 2024 Jul 1.

Apolipoprotein B: Bridging the Gap Between Evidence and Clinical Practice

Diana De Oliveira-Gomes  1 , Parag H Joshi  2 , Eric D Peterson  2 , Anand Rohatgi  2 , Amit Khera  2 , Ann Marie Navar  2
Affiliations
Review

Apolipoprotein B: Bridging the Gap Between Evidence and Clinical Practice

Diana De Oliveira-Gomes et al. Circulation. .

Abstract

Despite data suggesting that apolipoprotein B (apoB) measurement outperforms low-density lipoprotein cholesterol level measurement in predicting atherosclerotic cardiovascular disease risk, apoB measurement has not become widely adopted into routine clinical practice. One barrier for use of apoB measurement is lack of consistent guidance for clinicians on how to interpret and apply apoB results in clinical context. Whereas guidelines have often provided clear low-density lipoprotein cholesterol targets or triggers to initiate treatment change, consistent targets for apoB are lacking. In this review, we synthesize existing data regarding the epidemiology of apoB by comparing guideline recommendations regarding use of apoB measurement, describing population percentiles of apoB relative to low-density lipoprotein cholesterol levels, summarizing studies of discordance between low-density lipoprotein cholesterol and apoB levels, and evaluating apoB levels in clinical trials of lipid-lowering therapy to guide potential treatment targets. We propose evidence-guided apoB thresholds for use in cholesterol management and clinical care.

Keywords: apolipoproteins; cardiometabolic risk factors; lipoproteins; lipoproteins, LDL.

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Conflict of interest statement

Disclosures Dr Joshi has received honoraria from Regeneron and Bayer; research grants from the American Heart Association, Novo Nordisk, GlaxoSmithKline, Sanofi/Regeneron, AstraZeneca, and NASA; and is a stock shareholder for G3 Therapeutics. Dr Peterson has received research funding to his institution from BMS, Esperion, Janssen, and Amgen; and honoraria and consulting fees from Bayer, Janssen, Novo Nordisk, and Novartis. Dr Rohatgi has served as a consultant for CSL Limited, Raydel, and HDL Diagnostics; and received research grants from CSL and Quest. Dr Navar has received research funding to her institution from BMS, Esperion, and Janssen; and honoraria and consulting fees from Astra Zeneca, BI, Bayer, Janssen, Eli Lilly, Merck, Novo Nordisk, Novartis, New Amsterdam, Pfizer, and Silence Therapeutics. The remaining authors have no disclosures to report.

Figures

Figure 1.
Figure 1.
Schematic illustration of apoB-48 and apoB-100 containing lipoproteins.
Figure 2.
Figure 2.
Cholesterol mass and particle measures. This is a hypothetical representation of two patients with the same level of LDL-C but different levels of apoB. The patient with higher apoB has more atherogenic particles and therefore more cardiovascular risk.
Figure 3:
Figure 3:
Illustration of apoB 10th, 50th and 90th percentiles in different countries. Data from the USA obtained from NHANES 1988–1991. (43) Data from Canada obtained from random sample of men and women aged 18 to 74 years selected from Saskatchewan and Quebec 1989–1990. (49) Data from South Korea obtained from subjects residing in Seoul and Kyung-gee Do with an average age of 43.5 ± 8.3 years. (44) Data from India obtained from the health checkup program at Hinduja National Hospital. (48) Data from Mexico obtained from the 1990 National Census. (45) Data from Finland obtained from the population registers of the city of Turku and some adjacent rural and urban communities in southwestern Finland. (47) Data from Sweden obtained from Swedish population sample from 1985–1996 males and females, ages <20 to >80 years. (46)
Figure 4:
Figure 4:
Proportional reduction in LDL-C and apoB seen in lipid lowering therapy trials. Dotted line: best fit across all trials.
Figure 5:
Figure 5:
Achieved LDL-C and apoB levels in lipid lowering therapy trials. Dotted line: best fit across all trials.
See this image and copyright information in PMC

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