Update on apolipoprotein B. Issue 4 (August 2021)

• Record Type: Journal Article
• Authors: Sniderman, Allan; Langlois, Michel; Cobbaert, Christa
• Is Part Of: Current opinion in lipidology. Volume 32:Issue 4(2021)
• Publication Date: 2021-08
• Subjects: apolipoprotein B -- cardiovascular risk -- low-density lipoprotein cholesterol -- lipid lowering therapy -- non-high-density lipoprotein cholesterol; Lipids -- Periodicals; 572.574
• DOI: 10.1097/MOL.0000000000000754
• Languages: English
• ISSNs: 1473-6535

Abstract

Abstract : Purpose of review: The 2019 European Society of Cardiology/European Atherosclerosis Society Guidelines concluded that apolipoprotein B (apoB) was a more accurate measure of cardiovascular risk and a better guide to the adequacy of lipid lowering than low-density lipoprotein cholesterol (LDL-C) or non-high-density lipoprotein cholesterol (HDL-C). Also, they stated that apoB can be measured more accurately than LDL-C or non-HDL-C. This strong endorsement of the central role of apoB contrasts with the limited endorsement of apoB by the 2018 American College of Cardiology/American Heart Association Multisociety Guidelines. Nevertheless, both retained LDL-C as the primary metric to guide statin/ezetimibe/Proprotein convertase subtilisin/kexin type 9 (PCSK9) therapy. Recent findings: This essay will review the most important recent advances in knowledge about apoB with particular emphasis on the results of Mendelian randomization studies and a new discordance analysis in subjects on statin therapy. We will also lay out why using LDL-C to guide the adequacy of lipid lowering therapy represents an interpretive error of the results of the statin/ezetimibe/PCSK9 inhibitor randomized clinical trials and therefore why apoB should be the primary metric to guide statin/ezetimibe/PCSK9 therapy. Summary: There is now a robust body of evidence demonstrating the superiority of apoB over LDL-C and non-HDL-C as a clinical marker of cardiovascular risk. LDL-C is not the appropriate marker to assess the benefits of statin/ezetimibe/PCSK9 therapy.