Apolipoproteins better than cholesterol for predicting cardiovascular disease?

February 27, 2003

Authors of a review in this week's issue of THE LANCET outline how the measurement of lipid molecules called apolipoproteins could be more reliable indicators of cardiovascular disease than the measurement of LDL ('bad') cholesterol.

Allan Sniderman from the Mike Rosenbloom Laboratory for Cardiovascular Research, Montreal, Canada, Goran Walldius from AstraZeneca and the Karolinska Institute, Stockholm, Sweden, and colleagues review the current evidence comparing the potential of apolipoprotein measurement with cholesterol to predict reduction of cardiac risk in people using statins.

The authors comment how the results of four large prospective studies have shown that apolipoprotein B is superior to total cholesterol or LDL cholesterol to predict the risk of vascular disease. They also report that the ratio of apolipoprotein B/apolipoprotein A-1 is superior to the conventional LDL /HDL cholesterol ratio as an overall index of cardiovascular risk.

Based on their review of results from large statin trials apolipoproteins are also thought to be more sensitive markers than LDL cholesterol for people using statins. Goran Walldius comments: "Statin treatment to reduce risk of vascular disease is well established and will become ever more common. LDL cholesterol concentration is now used in clinical practice as the prime index of risk of vascular disease and the main target for therapy. However, data now suggest that values of apolipoprotein B and the apolipoprotein B/apolipoprotein A-1 ratio are more sensitive indices of risk of vascular disease-and are more robust predictors of future vascular events for patients on statin therapy-than concentrations of LDL cholesterol, non-HDL cholesterol, or the LDL/HDL cholesterol ratio. Thus, apolipoprotein B-guided statin therapy should be more effective in prevention of vascular events than treatment guided by LDL cholesterol."
Contact: Dr Goran Walldius, AstraZeneca, S-43183 Molndal, Sweden;
T) 46-31-776-2678; 46-70-676-0007;
F) 46-31-776-3713;
E) goran.walldius@astrazeneca.com


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