Apolipoprotein A-I versus HDL cholesterol in the prediction of risk for myocardial infariction and stroke

Purpose of review To compare the potential of high-density lipoprotein (HDL) cholesterol and apolipoprotein (apo) A-1, the major protein in HDL particles, in predicting cardiovascular risk. Pros and cons for using these risk markers are discussed. Recent findings Both HDL cholesterol and apoA-1 are in most clinical conditions antiatherogenic - the higher the values, the lower the cardiovascular risk, Methodological and physiological factors speak in favour of using apoA-1 rather than HDL cholesterol as a marker of risk. In prospective risk studies and in lipid-lowering trials it has been shown that the apoB/A-1 ratio, which reflects the cholesterol balance between all potentially atherogenic (apoB) and antiatherogenic lipoproteins (apoA-1), is a better risk marker than low-density lipoprotein cholesterol, HDL cholesterol and lipid ratios in predicting cardiovascular risk and response to lipid lowering induced by statins. Practical advantages speak in favour of using apoB and apoA-1 - fasting is not needed to analyze and interpret the values of apoB and apoA-1. Summary New guidelines should be developed in which target values for apoB and apoA-1 are defined to enable the use of these new strong risk markers/factors in clinical practice.