The joint effects of apolipoprotein B, apolipoprotein A1, LDL cholesterol, and HDL cholesterol on risk: 3510 cases of acute myocardial infarction and 9805 controls.Report as inadecuate




The joint effects of apolipoprotein B, apolipoprotein A1, LDL cholesterol, and HDL cholesterol on risk: 3510 cases of acute myocardial infarction and 9805 controls. - Download this document for free, or read online. Document in PDF available to download.

Reference: Parish, S, Peto, R, Palmer, A et al., (2009). The joint effects of apolipoprotein B, apolipoprotein A1, LDL cholesterol, and HDL cholesterol on risk: 3510 cases of acute myocardial infarction and 9805 controls. European heart journal, 30 (17), 2137-2146.Citable link to this page:

 

The joint effects of apolipoprotein B, apolipoprotein A1, LDL cholesterol, and HDL cholesterol on risk: 3510 cases of acute myocardial infarction and 9805 controls.

Abstract: AIMS: Plasma levels of apolipoprotein B (apoB), the main surface protein on LDL particles, and LDL-C, the amount of cholesterol in those particles, are closely correlated and, considered separately, are positive risk factors. Plasma levels of apolipoprotein A(1), the main surface protein on HDL particles, and HDL-C, the amount of cholesterol in those particles, are also closely correlated with each other and, considered separately, are negative risk factors. The interdependence of these four risk factors is unclear. METHODS AND RESULTS: Case-control study among 3510 acute myocardial infarction patients (without prior vascular disease, diabetes, or statin use) in UK hospitals and 9805 controls. Relative risks (age, sex, smoking, and obesity-adjusted) were more strongly related to apoB than to LDL-C and, given apoB, more strongly negatively related to apoA(1) than to HDL-C. The ratio apoB/apoA(1) was uncorrelated with time since symptom onset in cases, was reproducible in samples collected a few years apart in controls (correlation 0.81), and encapsulated almost all the predictive power of these four measurements. Its effect was continuous, substantial throughout the UK normal range [relative risk, top vs. bottom decile of this ratio, 7.3 (95% CI 5.8-9.2)] and varied little with age. The ratio apoB/apoA(1) was substantially more informative about risk (chi(1)(2) = 550) than were commonly used measures such as LDL-C/HDL-C, total/HDL cholesterol, non-HDL cholesterol, and total cholesterol (chi(1)(2) = 407, 334, 204, and 105, respectively). Given apoB and apoA(1), the relationship with risk of LDL-C was reversed, and this reversal was strengthened by appropriate allowance for random measurement errors in two correlated variables. Given usual apoB, lower LDL-C (consistent with smaller LDL particles) was associated with higher risk (P < 0.0001). During the first 8 h after symptom onset HDL-C increased by about 10%, precluding reliable assessment of the joint relationship of apoA(1) and pre-onset HDL-C with risk in such retrospective case-control studies. CONCLUSION: Apolipoprotein ratios are more informative about risk than lipid fractions are. This suggests that, among lipoprotein particles of a particular type (LDL or HDL), some smaller and larger subtypes differ in their effects on risk. Direct measurements of even more specific subtypes of lipoprotein particles may be even more informative about risk.

Peer Review status:Peer reviewedPublication status:PublishedVersion:Publisher's version Funder: Medical Research Council   Funder: British Heart Foundation   Funder: Cancer Research UK   Notes:Copyright © 2009 Parish et al. Published by Oxford University Press on behalf of European Society of Cardiology. The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions[at]oxfordjournals.org

Bibliographic Details

Publisher: Oxford University Press

Publisher Website: http://global.oup.com/

Journal: European heart journalsee more from them

Publication Website: http://eurheartj.oxfordjournals.org/

Issue Date: 2009-9

pages:2137-2146Identifiers

Urn: uuid:cbeaf9fc-fe9f-4683-86fc-ef09d9fd721f

Source identifier: 34754

Eissn: 1522-9645

Doi: https://doi.org/10.1093/eurheartj/ehp221

Issn: 0195-668X Item Description

Type: Journal article;

Language: eng

Version: Publisher's versionKeywords: International Studies of Infarct Survival Collaborators Humans Myocardial Infarction Apolipoprotein A-I Apolipoproteins B Risk Assessment Case-Control Studies Age Factors Cholesterol, HDL Cholesterol, LDL Adult Aged Middle Aged Risk Factors Sex Factors Female Male Tiny URL: pubs:34754

Relationships





Author: Parish, S - institutionUniversity of Oxford Oxford, MSD, Clinical Medicine, Clinical Trial Service Unit, BHF Centre of Research E

Source: https://ora.ox.ac.uk/objects/uuid:cbeaf9fc-fe9f-4683-86fc-ef09d9fd721f



DOWNLOAD PDF




Related documents