Importance of determining apolipoproteins B and A-1 in clinical practice

Authors: H. Vaverková
Published in: Kardiol Rev Int Med 2012, 14(3): 153-156


Apolipoproteins (Apo) are protein components of lipoprotein macromolecules. They fulfil various functions that can affect the destiny of lipoprotein particles, thus influencing the atherogenesis process. In terms of cli­nical practice, only the determination of ApoB has been of importance so far: ApoB is an indicator of the total number of atherogenic particles as well as a good surrogate marker of the number of small dense LDL (sdLDL). According to the ESC/EAS 2011 guidelines, ApoB should be considered an alternative risk marker in patients with combined hyperlipidemia, metabolic syndrome, diabetes and chronic kidney disease. In these patients, ApoB is also a secondary target indicator of treatment efficacy. Neither ApoA-1 nor the ApoB/ApoA-1 ratio is suitable for assessing treatment efficacy.

apolipoprotein B – apolipoprotein A-1 – LDL-cholesterol – cardiovascular risk – guidelines – lipid-lowering therapy


1. Grundy SM, Cleeman JI, Merz CN et al. National Heart, Lung, and Blood Institute; American College of Cardiology Foundation; American Heart Association. Implication of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation 2004; 110: 227–239.

2. Authors/Task Force Members. Perk J, De Backer G, Gohlke H et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012); The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) *Developed with the special contribution of the EuropeanAssociation for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2012; 33: 1635–1701. doi:10.1093/eurheartj/ehs092.

3. European Association for Cardiovascular Prevention & Rehabilitation. Reiner Z, Catapano AL, De Backer G et al. ESC/EAS Guidelines for the management of dyslipidaemias. The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J 2011; 32: 1769–1818.

4. Cromwell WC, Otvos JD, Keynes MJ et al. LDL particle number and risk of future cardiovascular disease in Framingham Offspring Study: implications for LDL management. J Clin Lipidol 2007; 1: 583–592.

5. Kathiresan S, Otvos JD, Sullivan LM et al. Increas­­ed small low-density lipoprotein particle number. A prominent feature of the metabolic syndrome in the Framingham Heart Study. Circulation 2006; 113: 20–29.

6. Han JH, Park HS, Kim JA et al. Apolipoprotein B is a better marker than non-HDL-cholesterol for the metabolic syndrome in Koreans. Atherosclerosis 2008; 197: 333–338.

7. Sniderman AD, Lamarche B, Tilley J et al. Hypertriglyceridemic hyperapoB in type 2 diabetes. Diabetes Care 2002; 25: 579–582.

8. Veerkamp MJ, de Graaf J, Stalenhoef AF. Role of insulin resistance in familial combined hyperlipidemia. Arterioscler Thromb Vasc Biol 2005; 25: 1026–1031.

9. Koba S, Yokota Y, Hirano T et al. Small LDL-cholesterol is superior to LDL-cholesterol for determining severe coronary atherosclerosis. J Atheroscler Thromb 2008; 15: 250–260.

10. Contois JH, McConnell JP, Sethi AA et al. AACC Lipoproteins and Vascular Diseases Division Working Group on Best Practices. Apolipoprotein B and cardiovascular disease risk: position statement from the AACC Lipoproteins and Vascular Diseases Division Working Group on Best Practices. Clin Chem 2009; 55: 407–419.

11. Jacobson TA. Opening a new lipid “apo-thecary”: incorporating apolipoproteins as potential risk factors and treatment targets to reduce cardiovascular risk. Mayo Clin Proc 2011; 86: 762–780.

12. Sniderman AD, Williams K, Contois JH et al. A meta-analysis of low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B as markers of cardiovascular risk. Circ Cardio­vasc Qual Outcomes 2011; 4: 337–345.

13. Walldius G, Jungner I, Holme I et al. High apolipoprotein B, low apolipoprotein A-I, and improvement in the prediction of fatal myocardial infarction (AMORIS study): a prospective study. Lancet 2001; 358: 2026–2033.

14. The Emerging Risk Factors Collaboration. Di Angelantonio E, Sarwar N, Perry P et al. Major Lipids, apolipoproteins, and risk of vascular disease. JAMA 2009; 302: 1993–2000.

15. The Emerging Risk Factors Collaboration. Lipid--Related Markers and Cardiovascular Disease Prediction. JAMA 2012; 307: 2499–2506.

16. Gotto AM Jr, Whitney E, Stein EA et al. Relation between baseline and on-treatment lipid parameters and first acute major coronary events in the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS). Circulation 2000; 101: 477–484.

17. Simes RJ, Marschner IC, Hunt D et al. LIPID Study Investigators. Relationship between lipid levels and clinical outcomes in the Long-Term Intervention with Pravastatin in Ischemic Disease (LIPID) Trial: to what extent is the reduction in coronary events with pravastatin explained by on-study lipid levels? Circulation 2002; 105: 1162–1169.

18. Roeters van Lennep JE, Westerveld T, Roeters van Lennep HW et al. Apolipoprotein concentrations during treatment and recurrent coronary artery disease events. Arterioscler Thromb Vasc Biol 2000; 20: 2408–2413.

19. Kastelein JJP, van der Steeg WA, Holme I et al. TNT Study Group. IDEAL Study Group. Lipids, apolipoproteins, and their ratios in relation to cardiovascular events with statin treatment. Circulation 2008; 117: 3002–3009.

20. Sniderman AD. Differential response of cholesterol and particle measures of atherogenic lipoproteins to LDL-lowering therapy: implications to clinical practice. J Clin Lipidol 2008; 2: 36–42.

21. Brunzell JD, Davidson M, Furberg CD et al. American Diabetes Association. American College of Cardio­logy Foundation. Lipoprotein management in patients with cardiometabolic risk: consensus statement from the American Diabetes Association and the American College of Cardiology Foundation. Diabetes Care 2008; 31: 811–822.

22. Vaverková H, Soška V, Rosolová H et al. Doporučení pro diagnostiku a léčbu dyslipidemií v dospělosti, vypracované výborem Česlé společnosti pro aterosklerózu. Vnitř Lek 2007; 53: 181–187.

23. Stein EA, Sniderman A, Laskarzewski P. Assessment of reaching goal in patients with combined hyperlipidemia: low-density lipoprotein cholesterol, non--high-density lipoprotein cholesterol, or apolipoprotein B. Am J Cardiol 2005; 96 (Suppl): 36K–43K.

24. Vaverkova V, Frohlich J, Jackuliakova D et al. Comparison of apolipoprotein B and plasma lipids as targets for lipid lowering treatment. Clin Biochem 2005; 38: 509–513.

25. Ballantyne CM, Raichlen JS, Cain VA. Statin therapy alters the relationship between apolipoprotein B and low-density lipoprotein cholesterol and non-high--density lipoprotein cholesterol targets in high-risk patients. The MERCURY II (Measuring Effective Reductions in Cholesterol Using Rosuvastatin therapy II) Trial. J Am Coll Cardiol 2008; 52: 626–632.

26. Vaverkova H, Farnier M, Averna M et al. Switching from statin monotherapy to ezetimibe/simvastatin or rosuvastatin modifies the relationships between apolipoprotein B, LDL cholesterol, and non-HDL cholesterol in patients at high risk of coronary disease. Clin Bio­chem 2011; 44: 627–634.

27. Vaverkova H, Karasek D, Novotny D et al. Apolipoprotein B versus LDL-cholesterol: Association with other risk factors for atherosclerosis. Clin Biochem 2009; 42: 1246–1251.

28. Sattar N, Williams K, Sniderman AD et al. Comparison of the associations of apolipoprotein B and non-HDL cholesterol with other cardiovascular risk factors in patients with metabolic syndrome in the Insulin Resistance Study (IRAS). Circulation 2004; 110: 2687–2693.

29. Vaverková H. LDL-C or apoB as the best target for reducing coronary heart disease: should apoB be implemented into clinical practice? Clin Lipidol 2011; 1: 35–48.

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