A meta-analysis of low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B as markers of cardiovascular risk.
Level 1 - systematic review of randomized trials
Meta-analysis of prospective epidemiological cohort studies evaluating risk markers
PubMed 21487090 · doi:10.1161/CIRCOUTCOMES.110.959247
What was done
A quantitative meta-analysis was performed using published epidemiological studies that evaluated relative risks of non-HDL-C and apolipoprotein B (apoB) for fatal or nonfatal ischemic cardiovascular events. Data from 12 independent reports comprising 233,455 subjects and 22,950 events were converted to standardized relative risk ratios (RRRs) and evaluated using random-effects models.
What was found
ApoB was the strongest cardiovascular risk marker (RRR 1.43; 95% CI, 1.35 to 1.51), followed by non-HDL-C (RRR 1.34; 95% CI, 1.24 to 1.44), and LDL-C (RRR 1.25; 95% CI, 1.18 to 1.33). Within-study comparisons showed apoB RRR was 5.7% higher than non-HDL-C (P < 0.001) and 12.0% higher than LDL-C (P < 0.0001), while non-HDL-C RRR was 5.0% higher than LDL-C (P = 0.017). HDL-C accounted for a substantial portion of variance across studies. Modeling a 10-year treatment strategy for US adults above the 70th percentile projected that non-HDL-C targeting would prevent 300,000 more events than LDL-C, and an apoB strategy would prevent 500,000 more events than non-HDL-C.
Why it matters
This meta-analysis indicates that apoB and non-HDL-C are superior markers of cardiovascular risk compared to standard LDL-C, supporting the routine clinical use of apoB for risk stratification.
Limits
The analysis relies on observational epidemiological studies rather than randomized treatment trials targeting specific apoB or non-HDL-C thresholds. The clinical event projections are theoretical model estimates based on population percentiles rather than direct trial outcomes, and heterogeneity between included studies was present.
Cited by
- supports Multiple major cardiology studies show that ApoB is a superior predictor of cardiovascular events compared to LDL cholesterol alone.