Barter, P. J. et al. ApoB versus cholesterol in estimating cardiovascular risk and in guiding therapy: report of the thirty-person/ten-country panel. J. Intern. Med. 259, 247-258

Laval University, Quebec City, Quebec, Canada
Journal of Internal Medicine (Impact Factor: 6.06). 03/2006; 259(3):247-58. DOI: 10.1111/j.1365-2796.2006.01616.x
Source: PubMed


There is abundant evidence that the risk of atherosclerotic vascular disease is directly related to plasma cholesterol levels. Accordingly, all of the national and transnational screening and therapeutic guidelines are based on total or LDL cholesterol. This presumes that cholesterol is the most important lipoprotein-related proatherogenic risk variable. On the contrary, risk appears to be more directly related to the number of circulating atherogenic particles that contact and enter the arterial wall than to the measured concentration of cholesterol in these lipoprotein fractions. Each of the atherogenic lipoprotein particles contains a single molecule of apolipoprotein (apo) B and therefore the concentration of apo B provides a direct measure of the number of circulating atherogenic lipoproteins. Evidence from fundamental, epidemiological and clinical trial studies indicates that apo B is superior to any of the cholesterol indices to recognize those at increased risk of vascular disease and to judge the adequacy of lipid-lowering therapy. On the basis of this evidence, we believe that apo B should be included in all guidelines as an indicator of cardiovascular risk. In addition, the present target adopted by the Canadian guideline groups of an apo B <90 mg dL(-1) in high-risk patients should be reassessed in the light of the new clinical trial results and a new ultra-low target of <80 mg dL(-1) be considered. The evidence also indicates that the apo B/apo A-I ratio is superior to any of the conventional cholesterol ratios in patients without symptomatic vascular disease or diabetes to evaluate the lipoprotein-related risk of vascular disease.

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Available from: Curt D Furberg, Sep 12, 2014
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    • "An increase in blood FFA and Apo B levels is known to reflect an increase in LDL, which is most susceptible to oxidation by active oxygen metabolites [15,16]. Oxidized LDL is thought to reflect excess production and accumulation of LDL in the blood. "
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    ABSTRACT: Background Free fatty acids (FFA), oxidized low-density lipoprotein (LDL) and its antibodies, lipid profile markers, which are formed under oxidative stress, play an important role in atherosclerotic disease. Assess the levels of these markers in myocardial infarction patients depending on the extent of coronary artery disease (CAD). Methods ST-elevation MI patients with hemodynamically significant stenoses of ≥75% in one, two, three, or more coronary arteries were examined. The patients were divided into three groups according to the severity of coronary lesions. Patients had a ≥75% stenotic lesion in one coronary artery (group 1, n = 135), two coronary arteries (group 2, n = 115), or three or more coronary arteries (group 3, n = 150). The control group comprised healthy subjects (n = 33). Results FFA levels on day 1 from MI onset were higher in groups 1, 2, and 3 compared with controls. On day 1 from MI onset, oxidized LDL levels were significantly higher in groups 2 and 3 than those in controls (both р = 0.001). Oxidized LDL levels were significantly higher in patients with multivessel CAD compared with those with single-vessel CAD on days 1 and 12. Antibody levels increased with the number of affected arteries. Conclusion High levels FFA, oxidized LDL and its antibody, lipid profile markers, and parameters of the pro/antioxidant systems persist during the subacute phase of MI.
    Full-text · Article · Jul 2014 · Lipids in Health and Disease
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    • "Atherosclerosis is characterized by a constant insult of inflammation on the arteries, and it has been established that this inflammation primarily is caused by an accumulation/retention of LDL in the artery wall.19,20 ApoB is the structural protein of LDL and elevated levels of apoB or LDL are positively associated with cardiovascular disease.21,22,23 Today, lipid-lowering drugs such as statins are the most effective pharmaceutical treatment for regulating LDL cholesterol levels. "
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    ABSTRACT: Target substrate-specific hammerhead ribozyme cleaves the specific mRNA efficiently and results in the inhibition of gene expression. In humans, overproduction of apolipoprotein B (apoB) is positively associated with premature coronary artery diseases. The goal of this study is to demonstrate that long-term reduction of apoB gene expression using hammerhead ribozyme would result in inhibition of atherosclerosis development. We designed two hammerhead ribozymes targeted at the nucleotides of apoB mRNA GUC(2326) (designated RB1) and GUA(6679) (designated RB15), and we used self-complementary adeno-associated virus 8.2 (scAAV8.2) vector to deliver these active ribozymes of RB1, RB15, combination of RB1/RB15, and an inactive hammerhead ribozyme RB15 mutant to atherosclerosis-prone LDb mice (Ldlr(-/-)Apobec1(-/-)). LDb mice lack both low density lipoproteins (LDL) receptor (Ldlr(-/-)) and apoB mRNA editing enzyme (Apobec1(-/-)) genes and develop atherosclerosis spontaneously. After the RB1, RB15, or combination of RB1/RB15 ribozymes treatment, the LDb mice had significantly decreased plasma triglyceride and apoB levels, resulting in markedly decreased of atherosclerotic lesions, Furthermore, the active ribozymes treatment decreased the levels of diacylglycerol acyltransferase 1 (Dgat1) mRNA and the levels of multiple diacylglycerol (DAG) molecular species. These results provide the first evidence that decreased apoB levels results to reduction of Dgat1 expression and triglyceride levels (TAG), which had a significant impact on the development of atherosclerosis.Molecular Therapy-Nucleic Acids (2013) 2, e125; doi:10.1038/mtna.2013.53; published online 1 October 2013.
    Full-text · Article · Oct 2013 · Molecular Therapy - Nucleic Acids
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    • "Several large prospective studies have demonstrated that the apoB level is a better predictor of cardiovascular risk than any other lipid measurements [2]–[4]. In the AMORIS study, apoB was found to be superior to LDL cholesterol as a marker to assess cardiovascular risk, particularly in patients with normal or low LDL cholesterol levels [2]. "
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    ABSTRACT: Several large prospective studies have demonstrated that apolipoprotein B (apoB) has greater value in predicting cardiovascular risk than any other lipid measurements. Currently, however, serum apoB levels are not routinely measured, because of the additional cost. The aim of this study was to develop an equation to estimate apoB from conventional lipid measurements including total cholesterol, HDL cholesterol, and triglycerides. Data from a total of 78,127 subjects (47,057 men and 31,070 women), aged 15 to 88 years (mean age 41.8 years) were reviewed to develop an apoB equation. Additional datasets from the same institution and the NHANES obtained in 2007-2008 were used for internal (n = 73,445) and external validation (n = 3,097), respectively. We developed an apoB equation based on a linear regression model that contains total cholesterol, triglycerides, and HDL cholesterol as terms (model 1). To more precisely estimate the serum apoB level, we adjusted mode1 1 using a cutoff serum triglyceride value of 270 mg/dl (model 2). Model 2 showed more randomly distributed residuals in patients with diabetes, atherogenic dyslipidemia, and those taking lipid-lowering agents than model 1. The residuals in the development, internal validation, and external validation datasets were also randomly distributed around 0 with no clear trends. The new equation we developed to estimate serum apoB concentrations is accurate and can be used in diverse subgroups of patients including those with diabetes, atherogenic dyslipidemia, and those taking lipid-lowering agents.
    Full-text · Article · Dec 2012 · PLoS ONE
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