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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2001;21:2100.)
© 2001 American Heart Association, Inc.

Letters to the Editor

Familial Combined Hyperlipidemia and Insulin Resistance

Jiri Frohlich; Allan Sniderman

University of British Columbia, Vancouver, Canada
McGill University, Quebec, Canada

To the Editor:

In the last paragraph of this editorial (Arterioscler Thromb Vasc Biol. 2001;21:469–470), Dr Eckel mentions that assays for apo B remain less than optimal and quotes our article that deals with standardization of the DAIS Study.¹ In fact, after the decision was made on a common International Federation of Clinical Chemistry/World Health Organization standard for the 2 laboratories involved in DAIS, there was very little bias in the apo B values (see Figure 5A of our article). Apo B assays have been standardized^2,3 and reference values established in both the United States and Canada (for a review, see Bhatnagar et al⁴).

Plasma apo B concentration, a measure of LDL particle number, has been shown in both epidemiological studies and prospective, double-blind, placebo controlled clinical trials to be related to clinical outcomes.^5–7 In the Quebec Cardiovascular Study,⁵ apo B was the single most important lipid parameter that predicted cardiovascular events. Similarly, data from AFCAPS/TEXCAPS⁶ have demonstrated that although LDL cholesterol, HDL cholesterol, and apo B predict cardiac outcomes before therapy is initiated, the lipid levels and their ratios did not predict outcome on treatment, whereas apo B and the ratio of apo B to apo A1 did. Similarly, on treatment, apo B and apo A1 were the significant predictors in a secondary prevention study of van Lennep et al.⁷ This also fits well with observational data by Moss and colleagues⁸ in 1045 postinfarction patients. Target values have been established and accepted by the Canadian Cardiovascular Society.⁹

Although apo . . . [Full Text of this Article]

Robert H. Eckel

Department of Medicine, Physiology, and Biophysics, University of Colorado Health Sciences Center, Denver, Colorado