Use of lipoprotein particle measures for assessing coronary heart disease risk post-American Heart Association/American College of Cardiology guidelines: the Multi-Ethnic Study of Atherosclerosis.
Level 3 - non-randomized controlled study
Prospective multi-ethnic observational cohort study evaluating prognostic biomarkers
PubMed 25477346 · doi:10.1161/ATVBAHA.114.304349
What was done
Cox regression analysis was performed on 4,679 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) to evaluate whether lipoprotein particle measures (ApoB, ApoB/ApoA-I, total LDL-P, and LDL-P/HDL-P ratio) predict primary incident coronary heart disease (CHD) events. Incremental predictive utility beyond standard lipid variables and the American Heart Association/American College of Cardiology (AHA/ACC) risk calculator was assessed using net reclassification improvement and C-statistics.
What was found
After adjustment for nonlipid variables, fourth-quartile levels compared with first quartiles showed significantly increased CHD risk: ApoB (hazard ratio [HR], 1.84; 95% CI, 1.25–2.69), ApoB/ApoA-I (HR, 1.91; 95% CI, 1.32–2.76), total LDL-P (HR, 1.77; 95% CI, 1.21–2.58), and LDL-P/HDL-P ratio (HR, 2.28; 95% CI, 1.54–3.37). These associations attenuated after adjustment for standard lipid panel variables. Adding measures to the AHA/ACC risk calculator yielded significant net reclassification improvement for ApoB/ApoA-I (0.18; P=0.007) and LDL-P/HDL-P (0.15; P<0.001), but C-statistics showed no significant improvement in CHD event discrimination for any lipoprotein measure.
Why it matters
These findings support AHA/ACC guidelines suggesting limited clinical utility for routine lipoprotein particle testing, as particle measures fail to improve risk discrimination beyond standard lipid profiles and calculators.
Limits
The abstract does not provide the duration of follow-up or the absolute number of CHD events. It also notes that potential utility in specific subgroups (e.g., individuals with normal standard cholesterol but discordant high particle counts) remains unaddressed.
Cited by
- supports Adding LDL particle number or subfraction measurements to standard cardiovascular risk formulas (which include age, sex, blood pressure, diabetes, LDL-C, and HDL-C) offers minimal additional statistical risk prediction because the variables are highly interrelated.