Both Serum Apolipoprotein B and the Apolipoprotein B/
Apolipoprotein A-I Ratio Are Associated with Carotid
Fei Huang1,2., Zhi Yang1,2., Baihui Xu1,2, Yufang Bi1,2, Min Xu1,2, Yu Xu1,2, Jieli Lu1,2, Yu Liu1,2,
Meng Dai1,2, Wenzhong Zhou1,2, Weiqing Wang1,2, Yuhong Chen1,2*
1Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, E-Institute of Shanghai
Universities, Shanghai, China, 2Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of
Endocrinology and Metabolism, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Background: Previous studies indicated that apolipoprotein measurements predicted cardiovascular disease (CVD) risk;
however, associations between apolipoproteins and carotid intima-media thickness (CIMT) were less explored.
Methodology and Principal Findings: The cross-sectional study included 6069 participants aged 40 years or older with NGT
from Shanghai, China. Serum fasting traditional lipids (total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C],
high-density lipoprotein cholesterol [HDL-C] and triglycerides [TG]), apoA-I and apoB were assessed. A high-resolution B-
mode ultrasonography was performed to measure CIMT. We found CIMT increased progressively across the quartiles of
serum apoB (p for trend ,0.0001). In logistic regression, concentrations of apoB (odds ratio [OR] 1.27, 95% confidence
interval [CI] 1.18–1.36), TC (OR 1.23, 95% CI 1.14–1.32), LDL-C (OR 1.25, 95% CI 1.16–1.34) and TG (OR 1.11, 95% CI 1.04–1.20)
were significantly related to elevated CIMT after adjusted for age and sex. Meanwhile, the apoB/apoA-I ratio (OR 1.25, 95%
CI 1.17–1.34) related to elevated CIMT. ApoB (OR 1.23, 95% CI 1.00–1.51) and the apoB/apoA-I ratio (OR 1.19, 95% CI 1.04–
1.36) remained significantly associated with elevated CIMT, after adjusted for the traditional CVD risk factors including
Conclusions and Significance: There were significant associations between serum apoB, the apoB/apoA-I ratio and
elevated CIMT. Serum apoB and the apoB/apoA-I ratio might be independent predictors of early atherosclerosis in NGT.
Citation: Huang F, Yang Z, Xu B, Bi Y, Xu M, et al. (2013) Both Serum Apolipoprotein B and the Apolipoprotein B/Apolipoprotein A-I Ratio Are Associated with
Carotid Intima-Media Thickness. PLoS ONE 8(1): e54628. doi:10.1371/journal.pone.0054628
Editor: Antonio Moschetta, University of Bari & Consorzio Mario Negri Sud, Italy
Received September 10, 2012; Accepted December 13, 2012; Published January 24, 2013
Copyright: ? 2013 Huang et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This study was supported by the grants from the Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health (1994DP131044), the
Sector Funds of Ministry of Health (201002002), the National Key New Drug Creation and Manufacturing Program of Ministry of Science and Technology
(2012ZX09303006-001), the Creative Research Group of Ministry of Education (IRT0932),National Nature Science Foundation of China (81170739, 81170719,
81222008, 30911120493), Shanghai Science and Technology Commission (09411954400), Shanghai Science and Technology Commission (10XD1403000),
Shanghai Natural Science Foundation (NO.10ZR1426400). The funders had no role in study design, data collection and analysis, decision to publish, or preparation
of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
* E-mail: firstname.lastname@example.org
. These authors contributed equally to this work.
Dyscholesterolemia, including higher low-density lipoprotein
cholesterol (LDL-C) and lower high-density lipoprotein cholesterol
(HDL-C) is identified as independent risk factor for the
development of cardiovascular disease (CVD) [1,2]. LDL-C is
widely used to assess the risk of vascular disease and the response
to therapy. Current guidelines for coronary heart disease (CHD)
prevention emphasize the use of total cholesterol (TC) and LDL-C
in CHD risk assessment [1,3]. However, there are accumulating
evidences suggesting that apolipoproteins are better predictors for
risk of CVD than traditional lipid parameters currently used in
clinical practice. Several large, prospective epidemiological studies
have shown that the apolipoprotein B (apoB) was a good predictor
for the occurrence of CVD in the general population. In statin-
treated patients with known CHD, apoB/apolipoprotein A-I
(apoA-I) ratio, but not LDL-C/HDL-C ratio, was positively
associated with clinical events . John et al  thought that apoB
should be added into the routine lipid panel for assessing and
monitoring patients at risk for adverse outcomes.
Intima-media thickness of the carotid arteries is an early marker
of atherosclerosis [6,7], and it is also demonstrated as a risk factor
for myocardial infarction and stroke in older adults . In type 2
diabetics, compared with conventional lipids, the apoB/apoA-I
ratio had a more closed association with carotid intima-media
thickness (CIMT) . Whether the same applies to subjects with
normal glucose tolerance (NGT) is less well defined.
This present study was to assess whether the associations of
apoB, apoA-I and the apoB/apoA-I ratio with CIMT were
independent of traditional CVD risk factors and clinical routine
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ApoB and ApoB/ApoA-I Ratio Related to CIMT
PLOS ONE | www.plosone.org7 January 2013 | Volume 8 | Issue 1 | e54628