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.
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
Graphical Abstract
Keywords
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Article info
Publication history
Published online: May 31, 2021
Accepted:
May 19,
2021
Received in revised form:
April 30,
2021
Received:
October 1,
2020
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
