The LDL-C/ApoB ratio predicts major cardiovascular events in patients with established atherosclerotic cardiovascular disease. (July 2021)

• Record Type: Journal Article
• Authors: Drexel, Heinz; Larcher, Barbara; Mader, Arthur; Vonbank, Alexander; Heinzle, Christine F.; Moser, Berthold; Zanolin-Purin, Daniela; Saely, Christoph H.
• Is Part Of: Atherosclerosis. Volume 329(2021)
• Page Start: 44
• Page End: 49
• Publication Date: 2021-07
• Subjects: LDL-C/ApoB ratio -- LDL particle size -- Prospective cohort study -- Major cardiovascular events -- Lipids -- Risk prediction -- Atherosclerosis; Arteriosclerosis -- Periodicals; Electronic journals; 616.136
• DOI: 10.1016/j.atherosclerosis.2021.05.010
• Languages: English
• ISSNs: 0021-9150

Abstract

Abstract: Background and aims: The low density lipoprotein cholesterol to Apolipoprotein B (LDL-C/ApoB) ratio is a validated proxy for low density lipoprotein (LDL) particle size that can be easily calculated from a standard lipid/apolipoprotein profile. Whether it is predictive of cardiovascular events in patients with established atherosclerosis is not known and is addressed in the present investigation. Methods: We determined the LDL-C/ApoB ratio in a cohort of 1687 subjects with established atherosclerosis. Prospectively, major cardiovascular events (MACE) including cardiovascular death, non-fatal myocardial infarction and non-fatal stroke were recorded over a period of 9.9 ± 4.6 years. The study covers >16, 000 patient-years. Results: At baseline, the LDL-C/ApoB ratio was 1.36 ± 0.28 in our cohort. During follow up, a total of 558 first MACE were recorded. The LDL-C/ApoB ratio predicted MACE in univariate Cox proportional hazard analysis (HR 0.90 [0.82–0.98]; p = 0.014); this finding was confirmed after adjustment for age, gender, intensity of statin treatment, hypertension, history of smoking, type 2 diabetes, body mass index and ApoB (HR 0.87 [0.78–0.97]; p = 0.013). Conclusions: The LDL-C/ApoB ratio is independently predictive of MACE in subjects with established atherosclerosis. Graphical abstract: Image 1 Highlights: LDL-C and ApoB are recommended targets for therapy in the latest ESC/EAS guidelines on dyslipidemia. The atherogenicity of LDL-C particles depends on their size, but measuring LDL particle size in clinical routine is not feasible. The LDL-C/ApoB ratio is an easily obtainable proxy of LDL size in clinical practice. We show that in patients with established cardiovascular disease this ratio independently predicts MACE. With new lipid-lowering drugs, e.g. triglyceride lowering agents, the LDL-C/ApoB ratio may be a valuable risk indicator.