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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2002;22:1918.)
© 2002 American Heart Association, Inc.

Atherosclerosis and Lipoproteins

Nonfasting Apolipoprotein B and Triglyceride Levels as a Useful Predictor of Coronary Heart Disease Risk in Middle-Aged UK Men

Philippa J. Talmud^*; Emma Hawe^*; George J. Miller; Steve E. Humphries

From the Division of Cardiovascular Genetics (P.J.T., E.H., S.E.H.), Department of Medicine, British Heart Foundation Laboratories, Rayne Building, Royal Free and University College Medical School, and MRC Epidemiology and Medical Care Unit (G.J.M.), Wolfson Institute of Preventive Medicine, Charterhouse Square, London, UK.

Correspondence to Dr Philippa Talmud, Division of Cardiovascular Genetics, British Heart Foundation Laboratories, Department of Medicine, Rayne Building, Royal Free and University College Medical School, 5 University St, London WC1E 6JJ, UK. E-mail p.talmud{at}ucl.ac.uk

Objective— The Apolipoprotein-related Mortality Risk (AMORIS) study concluded that the apolipoprotein (apo)B/apoA-I ratio was the best predictor of coronary heart disease (CHD) risk. We have compared the pairwise combinations of total cholesterol, triglycerides (TGs), apoB, high density lipoprotein (HDL) cholesterol, low density lipoprotein cholesterol, and apoA-I on CHD risk prediction in middle–aged men.

Methods and Results— Healthy middle-aged men (n=2508), free of CHD at baseline, were examined prospectively. Over 6 years of follow-up, there were 163 CHD events (including acute myocardial infarction, coronary artery surgery, and ECG evidence of silent myocardial infarction). The relative risk (RR) of CHD associated with cholesterol, TGs, apoB, apoA-I, apoB/apoA-I, low density lipoprotein cholesterol, and HDL cholesterol were examined by survival analysis. The apoB/apoA-I ratio was associated with the strongest effect on the RR (3.58, 95% CI 2.08 to 6.19). In multivariate analysis, apoA-I had no significant effect on risk. Examining RR by quartiles, apoB and HDL in combination (RR 8.38, 95% CI 3.21 to 21.92) were better predictors of CHD risk than apoB and TGs (RR 4.05, 95% CI 1.57 to 6.23). However, apoB and TGs in combination added risk information over and above lifestyle factors, whereas apoB and HDL cholesterol did not.

Conclusions— The combined evaluation of apoB with TGs provides useful diagnostic criteria for CHD risk.

Key Words: follow-up studies • apolipoprotein B • triglycerides • HDL cholesterol • apolipoprotein A-I

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