Association of the ApoB/ApoA1 Ratio with Angiographically Documented Coronary Artery Disease: Comparison with Conventional Lipid Markers.

Background/

Objectives

The apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) ratio has been proposed as an integrated marker of atherogenic and anti-atherogenic lipoprotein balance. This study assessed its association with the presence and angiographic severity of coronary artery disease (CAD) and compared its discriminatory performance with conventional lipid markers.

Methods

This retrospective, observational, cross-sectional study included 63 adults undergoing coronary angiography for suspected or established CAD. Pre-procedural ApoB, ApoA1, and conventional lipid parameters were measured. Significant CAD was defined as ≥50% stenosis in at least one major epicardial coronary artery. Associations with angiographic severity were assessed using Gensini and SYNTAX scores. Statistical analyses included between-group comparisons, Spearman correlations, ROC analysis with DeLong comparisons, and logistic regression.

Results

Significant CAD was present in 46 patients (73.02%). ApoB and ApoB/ApoA1 were higher in patients with significant CAD (p = 0.011 and p = 0.013), whereas ApoA1 was not (p = 0.101). ApoB/ApoA1 correlated weakly with Gensini score (ρ = 0.30, p = 0.046), but not with SYNTAX Scores I or II. In the complete-case subset (n = 55), ApoB/ApoA1 had an AUC of 0.68, with no significant differences versus LDL-C, HDL-C, total cholesterol, or triglycerides. Each 0.1-unit increase in ApoB/ApoA1 was associated with higher odds of significant CAD after adjustment for age, diabetes mellitus, and smoking (adjusted OR 1.63, 95% CI 1.08-2.48; p = 0.021).

Conclusions

ApoB/ApoA1 was associated with significant CAD after adjustment for selected clinical variables, but this association was attenuated after additional adjustment for LDL-C. Its discriminatory performance was modest and not significantly different from conventional lipid markers, requiring further evaluation as a potential pre-angiographic risk marker.