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TOPLINE:

Higher levels of non-high-density lipoprotein (non-HDL) cholesterol and apolipoprotein B (ApoB) were each associated with increased risks for atherosclerotic cardiovascular disease (ASCVD) and myocardial infarction (MI). Each marker independently improved risk prediction beyond the information provided by the other, and risk was highest when both marker levels were elevated.

METHODOLOGY:

• Researchers conducted a cohort study to assess whether baseline levels of non-HDL cholesterol and ApoB each added predictive value for ASCVD beyond the other, using data from the Copenhagen General Population Study.
• They included 94,398 Danish adults recruited between 2003 and 2015 who were not taking lipid-lowering drugs at baseline; 56% were women.
• Non-HDL cholesterol and ApoB levels were measured as continuous variables at baseline. Researchers used median values of 155 mg/dL for non-HDL cholesterol and 106 mg/dL for ApoB to assess threshold effects.
• Participants were divided into four groups on the basis of median values — concordant low (both non-HDL cholesterol and ApoB levels lower than median values), discordant high ApoB (ApoB levels greater than median values and non-HDL cholesterol levels lower than median values), discordant high non-HDL cholesterol (non-HDL cholesterol levels greater than median values and ApoB levels lower than median values), and concordant high (both levels greater than median values).
• Researchers tracked the occurrence of the first MI and ASCVD events over a median follow-up duration of 13.2 years.

TAKEAWAY:

• A total of 2462 first MI events and 5723 first ASCVD events occurred over the follow-up period. Each 1-SD increase in non-HDL cholesterol levels was linked to a 16% increased risk for ASCVD (adjusted hazard ratio [aHR], 1.16; 95% CI, 1.13-1.19), and each 1-SD increase in ApoB levels was linked to a 14% increased risk for ASCVD (aHR, 1.14; 95% CI, 1.12-1.17). Similar results were observed when assessing the risk for MI.
• When both markers were adjusted in the same model, the aHR for ASCVD was attenuated to 1.11 (95% CI, 1.05-1.18) for non-HDL cholesterol and to a statistically nonsignificant level for ApoB.
• Compared with participants with both marker levels below median values, those with discordant high ApoB alone had an aHR of 1.14 (95% CI, 1.01-1.29) for ASCVD and 1.32 (95% CI, 1.10-1.59) for MI.
• High levels of non-HDL cholesterol alone were associated with an aHR of 1.21 (95% CI, 1.06-1.38) for ASCVD and 1.30 (95% CI, 1.05-1.60) for MI. Participants with both marker levels greater than median values had an aHR of 1.36 (95% CI, 1.28-1.44) for ASCVD and 1.69 (95% CI, 1.53-1.85) for MI.

IN PRACTICE:

“These findings suggest that future guidelines on cholesterol-derived risk assessment may benefit from recommending the combined assessment of non-HDL-C [non-HDL cholesterol] and ApoB rather than reliance on either marker alone. That being said, if clinicians routinely assess non-HDLC, they will only miss approximately 5% of the population with discordantly high ApoB,” researchers of the study wrote.

SOURCE:

The study was led by Camilla Ditlev Lindhardt Johannesen, MD, PhD, Copenhagen University Hospital-Herlev Gentofte, Herlev, Denmark. It was published online on May 13 as a brief report in JAMA Cardiology.

LIMITATIONS:

The cohort was limited to White Danish individuals, restricting generalizability. The risk for residual confounding could not be excluded despite adjustment for known clinical risk factors. Researchers could not track changes in non-HDL cholesterol or ApoB levels over time.

DISCLOSURES:

The study received support from multiple sources, including Herlev and Gentofte Hospital, the Capital Region of Denmark, and Overlaege Johan Boserup og Lise Boserups Legat. Several authors reported receiving support from or being employed by Novo Nordisk. Another author reported having consultancies, speaking engagements, and receiving honoraria from multiple pharmaceutical or biotechnology companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.