Combined use of apolipoprotein B/apolipoprotein A1 ratio and non-high-density lipoprotein cholesterol before routine clinical lipid measurement in predicting coronary heart disease.

BACKGROUND AND AIMS: Our aim was to examine whether the combined use of apolipoprotein B (apoB)/apolipoprotein A1 (apoA1) and non-high-density lipoprotein cholesterol (non-HDL-C) was useful before routine clinical lipid measurement in predicting coronary heart disease (CHD).

PATIENTS AND METHODS: In total, 826 patients were enrolled and they were classified into a CHD group (532 cases) and a normal group (294 cases) according to the results of coronary angiography. Laboratory data including fasting lipid profile were obtained after an overnight fast. Serum apoB/apoA1 ratio and non-HDL-C were calculated. Logistic regression was applied to estimate the cross-sectional association between the apoB/apoA1 ratio, non-HDL-C, and CHD. Receiver operating characteristics curve analysis was used to determine the value of apoB/apoA1 ratio and non-HDL-C in the diagnosis of CHD.

RESULTS: The associations with an increased risk of CHD were much stronger for the apoB/apoA1 ratio [odds ratio (OR)=8.941, 95% confidence interval (CI) 4.363-18.323] than for non-HDL-C (OR=1.373, 95% CI 1.163-1.622). The patients in the top quartile of the apoB/apoA1 distribution had an OR of 7.321 (95% CI 3.891-13.771) compared with those in the bottom quartile. Patients with combined high levels of apoB/apoA1 and non-HDL-C (N=92, 79.31%) had the highest risk of CHD. The combined use of apoB/apoA1 ratio and non-HDL-C (0.762; 95% CI 0.677-0.847) showed greater receiver operating characteristics area than its individual components or other lipid profiles.

CONCLUSION: The combination of apoB/apoA1 and non-HDL-C had even greater predictive value than its individual components or other lipid profiles.