ApoB, LDL-C, and non-HDL-C as markers of cardiovascular risk.
Level 3 - non-randomized controlled study
Systematic review of observational cohort and discordance studies
PubMed 40681368 · doi:10.1016/j.jacl.2025.05.024
What was done
A systematic review (PubMed searched through September 30, 2024) evaluated discordance studies comparing the predictive performance of low-density lipoprotein cholesterol (LDL-C) and non-HDL-C against LDL particle number (LDL-P) or apolipoprotein B (apoB) for atherosclerotic cardiovascular disease risk. The review included 15 studies with a combined total of 593,354 participants, covering populations with and without statin therapy and utilizing median-, percentile-, residual-, and variance-based discordance analysis methods.
What was found
ApoB outperformed LDL-C in 9 of 9 studies. LDL-P was superior to LDL-C in 2 of 3 comparisons. In comparisons between apoB and non-HDL-C (9 studies total), apoB was significantly more accurate in 7 studies, equivalent in 1 study, and inferior to non-HDL-C in 1 study. The abstract did not report quantitative pooled effect sizes or confidence intervals.
Why it matters
This review shows that when lipid markers disagree, apoB is consistently more accurate at predicting cardiovascular risk than either LDL-C or non-HDL-C. It supports measuring apoB directly rather than relying on standard cholesterol measures as clinical surrogates.
Limits
The findings rely on qualitative synthesis (vote counting) rather than formal meta-analytic pooling, and the abstract provides no numerical effect estimates. The included studies used heterogeneous discordance methods (median-, percentile-, residual-, and variance-based). Specific cardiovascular endpoints, confounding control, and risk of bias across individual studies were not reported in the abstract.
Cited by
- supports ApoB or LDL particle number is a superior biomarker to LDL cholesterol, non-HDL cholesterol, triglycerides, and HDL cholesterol for distinguishing cardiovascular disease risk.