The apoB/apoA-1 ratio is better than the cholesterol ratios to estimate the balance between plasma proatherogenic and antiatherogenic lipoproteins and to predict coronary risk

Background: The apolipoprotein B (apoB)/apoA-1 ratio represents the balance of proatherogenic and anti-atherogenic lipoproteins. The purpose of this study was to determine whether the apoB/apoA-1 ratio was superior to any of the cholesterol ratios-total cholesterol/high-density lipoprotein cholesterol (TC/HDLC), low-density lipoprotein cholesterol (LDL-C)/HDL-C and non-HDL-C/HDL-C-in predicting the risk of coronary disease. Moreover, we examined whether any lipids, lipoproteins or cholesterol ratios add significant predictive information beyond that provided by the apoB/apoA-1 ratio. Methods: Plasma lipids, lipoproteins, apoB, and apoA-1 were measured in 69,030 men and 57,168 women above 40 years of age. After a mean follow-up of 98 months, 1183 men and 560 women had died from a myocardial infarction in this prospective apolipoprotein-related mortality risk (AMORIS) study. Results: High apoB and a high apoB/apoA-1 ratio were strongly related to increased coronary risk, while high apoA-1 was inversely related to risk. The apoB/apoA-1 ratio was superior to any of the cholesterol ratios in predicting risk. This advantage was most pronounced in subjects with LDL-C levels <3.6 mmol/l. Addition of lipids, lipoproteins or any cholesterol ratio to apoB/apoA-1 in risk models did not further improve the strong predictive value of apoB/apoA-1. Conclusions: These results indicate that the apoB/apoA-1 ratio is at present the best single lipoprotein-related variable to quantitate coronary risk. Given the additional advantages apolipoproteins possess-fasting samples are not required, apoB/apoA-1 is a better index of the adequacy of statin therapy than LDL-C, and the measurement of apoB and apoA-1 are standardized, whereas LDL-C and HDL-C are not-there would appear to be considerable advantage to integrating apolipoproteins into clinical practice.