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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2007;27:661.)
© 2007 American Heart Association, Inc.

Atherosclerosis and Lipoproteins

Improving Prediction of Ischemic Cardiovascular Disease in the General Population Using Apolipoprotein B

The Copenhagen City Heart Study

Marianne Benn; Børge G. Nordestgaard; Gorm Boje Jensen; Anne Tybjærg-Hansen

From the Department of Clinical Biochemistry (M.B., A.T.-H.), Rigshospitalet, Copenhagen University Hospital; Department of Clinical Biochemistry (M.B., B.G.N.), Herlev University Hospital; The Copenhagen City Heart Study (B.G.N., G.B.J., A.T.-H.), Bispebjerg University Hospital, University of Copenhagen, Denmark.

Correspondence to Anne Tybjærg-Hansen, MD, DMSc, Chief Physician and Associate Professor, Department of Clinical Biochemistry, KB3011, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark. E-mail at-h{at}rh.dk

Background— Apolipoprotein B (apoB) levels predict fatal myocardial infarction. Whether apoB also predicts nonfatal ischemic cardiovascular events is unclear. We tested the following hypotheses: apoB predicts ischemic cardiovascular events, and apoB is a better predictor of ischemic cardiovascular events than low-density lipoprotein cholesterol.

Methods and Results— We studied 9231 asymptomatic women and men from the Danish general population followed prospectively for 8 years and observed the following incident events: ischemic heart disease 591, myocardial infarction 278, ischemic cerebrovascular disease 313, ischemic stroke 229, and any ischemic cardiovascular event 807. Women with apoB in the upper versus the lower tertile had hazard ratios for ischemic heart disease of 1.8 (1.2 to 2.5), for myocardial infarction 2.6 (1.4 to 4.7), and for any ischemic cardiovascular event 1.8 (1.3 to 2.3), and men had hazard ratios for ischemic heart disease of 1.9 (1.5 to 2.6), for myocardial infarction 2.4 (1.5 to 3.6), and for any ischemic cardiovascular event 1.6 (1.3 to 2.1). Women had similar hazard ratios for ischemic cerebrovascular disease and ischemic stroke. ApoB had a higher predictive ability than low-density lipoprotein cholesterol in the prediction of ischemic heart disease, myocardial infarction, any ischemic cardiovascular event, and any nonfatal ischemic cardiovascular event in both genders (P=0.03 to <0.001). Finally, in smokers older than 60 years with systolic blood pressure >160 mm Hg, apoB contributed 11% in women and 15% in men to the increase in absolute 10-year risk from the lower to the upper apoB tertile.

Conclusion— ApoB predicts ischemic cardiovascular events in both genders, and is better than low-density lipoprotein cholesterol in this respect. We suggest that prediction of future ischemic cardiovascular events could be improved by measuring apoB.

Apolipoprotein B (apoB) levels predict fatal myocardial infarction in men. Whether apoB also predicts nonfatal ischemic cardiovascular events is unclear. In the present study we show that apoB level is a predictor of an increased risk of: ischemic heart disease and myocardial infarction not only in men but also in women; ischemic cerebrovascular disease and ischemic stroke in women; and any ischemic cardiovascular event in both genders.

Key Words: apolipoproteins • atherosclerosis • cardiovascular diseases • lipids • lipoproteins

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