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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2006;26:406.)
© 2006 American Heart Association, Inc.

Atherosclerosis and Lipoproteins

The Apolipoprotein B/AI Ratio and the Metabolic Syndrome Independently Predict Risk for Myocardial Infarction in Middle-Aged Men

Lars Lind; Bengt Vessby; Johan Sundström

From the Departments of Medical Sciences (L.L., J.S.) and Public Health and Caring Sciences (B.V., J.S.), Uppsala University, Sweden; and Astra Zeneca R&D (L.L.), Mölndal, Sweden.

Correspondence to Johan Sundström, Departments of Medical Sciences and Public Health & Caring Sciences/Geriatrics, PO Box 609, S-75125 Uppsala, Sweden (Kålsängsgränd 10D, S-75319 Uppsala, Sweden). E-mail johan.sundstrom{at}pubcare.uu.se

Background— Both the metabolic syndrome and an increased apolipoprotein B/AI (apoB/AI) ratio are powerful risk factors for cardiovascular events. We hypothesized that the apoB/AI ratio well-characterizes the dyslipidemia associated with insulin resistance and the metabolic syndrome and investigated those relations and if the apoB/AI ratio and the metabolic syndrome independently predicted subsequent myocardial infarction (MI).

Methods and Results— A community-based sample of 1826 men aged 50 was investigated at baseline and again at age 70. ApoB/AI ratio and the metabolic syndrome (National Cholesterol Education Program definition) were evaluated, and the incidence of fatal and nonfatal MI was followed for a median of 26.8 years from the age 50 baseline. ApoB/AI ratio was significantly higher in men with versus without the metabolic syndrome (P<0.0001), and increased with the number of components defining the syndrome (P<0.0001). ApoB/AI ratio was inversely related to euglycemic insulin clamp glucose disposal rate at age 70 (r=–0.34, P<0.0001). During follow-up from age 50, 462 subjects developed an MI. An apoB/AI ratio>=0.9 (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.15 to 1.91) and presence of the metabolic syndrome (HR, 1.69; 95% CI, 1.30 to 2.21) at baseline were independent predictors for MI, adjusting for low-density lipoprotein cholesterol and smoking.

Conclusion— The apoB/AI ratio was related to the metabolic syndrome, as well as to a direct measurement of insulin resistance. Despite this, the apoB/AI ratio and the metabolic syndrome were both independent long-term predictors of MI in a community-based sample of middle-aged men.

Key Words: apolipoprotein • insulin resistance • metabolic syndrome • myocardial infarction

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