Original article Herz 2014 DOI 10.1007/s00059-014-4147-5 Received: 7 May 2014 Revised: 31 July 2014 Accepted: 2 August 2014 © Urban & Vogel 2014

P. Liting · L. Guoping · C. Zhenyue Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai

Apolipoprotein B/apolipoprotein A1 ratio and non-high-density lipoprotein cholesterol Predictive value for CHD severity and prognostic utility in CHD patients

Coronary heart disease (CHD) is considered one of the leading causes of morbidity and mortality throughout the world. Low-density lipoprotein cholesterol (LDL-C) is considered a key determinant of cardiovascular risk and a primary marker for monitoring the efficacy of statin therapy [1]. However, the findings of studies in the past decade, such as the AMORIS [2] and INTERHEART study [3], have shown that the apolipoprotein (apo)B/apoA1 ratio, which mirrors the balance between proatherogenic and antiatherogenic lipoprotein particles, is a plausible way of characterizing cardiovascular risk independent of LDL-C levels [4, 5]. In addition, increasing evidence shows that non-high-density lipoprotein cholesterol (non-HDL-C), which is estimated by subtracting high-density lipoprotein cholesterol (HDL-C) from total cholesterol (TC) [6], is superior to LDL-C in predicting future cardiovascular events [7, 8, 9, 10]. However, whether LDL-C, apoB/A1, or non-HDL-C is the better marker of cardiovascular risk still remains controversial [11, 12]. Our previous study showed that both the apoB/apoA1 ratio and nonHDL-C were superior to other routine lipid profiles in predicting CHD risk, consistent with other studies [7, 13, 14]. We also found that the ratio was the best predictor among them, and the combination of apoB/apoA1 and non-HDL-C had even greater predictive value than its individual components or other lipid profiles. However, none of the previous studies have explored the clinical value of the combina-

tion of apoB/A1 and non-HDL-C in evaluating the severity of CHD and in predicting in-hospital CHD events and the longterm prognosis of CHD patients. Therefore, we conducted a retrospective study to examine the predictive value of apoB/ A1 and non-HDL-C for CHD severity and the prognostic utility of these two profiles in CHD patients.

Patients and methods Study design and study population Details of this study have been published previously [13]. Briefly, 826 patients (520 male and 306 female patients; mean age, 64.14±10.94 years) who had a complaint of chest pain or chest tightness and were suspected of having cardiovascular disease were enrolled in the study. All of them were admitted to the Department of Cardiology of the Shanghai Ruijin Hospital for clinically indicated coronary angiography between 2008 and 2012. The patients were divided into two groups according to their coronary angiography results: a CHD group (532 cases, lesion ≥50% of at least one major branch) and a normal group (294 cases, with normal coronary arteries). For further investigation, the patients who had at least one stenosis of ≥50% in any major vessel were further classified into single-branch (165 cases), double-branch (175 cases), and multi-branch (192 cases) groups. Data on anthropometry, lifestyle, and medical history were obtained at baseline. Laboratory examina-

tions and coronary angiography were performed, as the serum apoB/apoA1 ratio and non-HDL-C were calculated. Quantitative assessment of each vascular lesion was made according to the Gensini scoring system [15]. For further investigation, we also recorded the cut-off value of the quartile of apoB or apoB/apoA1 ratio and the non-HDL-C quartile in all patients. The cut-off values for apoB/apoA1 were: lower quartile, male 0.62, female 0.56; second quartile, male 0.76, female 0.72; upper quartile, male 0.96, female 0.89. The cutoff values for non-HDL-C (mmol/l) were: lower quartile, male 2.49, female 2.67; second quartile, male 3.17, female 3.36; upper quartile, male 3.89, female 4.10. The top quartile of the apoB/apoA1 group was defined as the high apoB/apoA1 ratio group (apoB/apoA1: ≥0.96 in male and ≥0.89 in female patients), and the top quartile of the non-HDL-C group was defined as the high non-HDL-C group (non-HDLC ≥3.89 mmol/l in male and ≥4.10 mmol/ l in female patients).

In-hospital prognosis and 3-year follow-up Major in-hospital adverse incidents were record, including new-onset/recurrent myocardial infarction, new-onset acute heart failure, malignant arrhythmia, stroke, cardiac death, and all-cause death. Follow-up telephone interviews were conducted 3 years after discharge. For the current study, we evaluated a combined Herz 2014 

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Original article Tab. 1  Lipid profiles of patients with different numbers of coronary artery branch lesions  

Normal group N=294

Doublebranch group N=175 1.76±1.06 4.42±0.99 1.09±0.29*** 2.72±0.85 3.33±0.97

Multi-branch group N=192

1.78±1.17 4.44±0.98 1.21±0.33 2.66±0.83 3.22±0.93

Single-branch group N=165 1.67±1.01 4.38±1.17 1.13±0.34** 2.68±0.98 3.25±1.10

TG (mmol/l) TC (mmol/l) HDL-C (mmol/l) LDL-C (mmol/l) Non-HDL-C (mmol/l) ApoA1 (g/l) ApoB (g/l) ApoB/apoA1

1.30±0.33 0.88±0.22 0.71±0.23

1.25±0.38 0.90±0.25 0.77±0.27*

1.18±0.29***# 0.91±0.23 0.81±0.28***

1.09±0.22***###@@ 0.97±0.24***##@ 0.92±0.30***###@@@

1.77±1.27 4.62±1.03*# 1.08±0.29*** 2.86±0.88**# 3.54±1.01**##@

Apo apolipoprotein, HDL-C high-density lipoprotein cholesterol, LDL-C low-density lipoprotein cholesterol, TG triglyceridesCompared with the normal group: *p