Apolipoprotein B and non-high-density lipoprotein cholesterol and risk of coronary heart disease in Chinese

Kuo-Liong Chien, Hsiu-Ching Hsu, Ta-Chen Su, Ming-Fong Chen, Yuan-Teh Lee, and Frank B. Hu

Institute of Preventive Medicine, National Taiwan University, Taipei 100

Corresponding Author: klchien{at}ha.mc.ntu.edu.tw

Whether apolipoprotein B (Apo B) and non-high-density lipoprotein cholesterol (non-HDL-C) are superior to low-density lipoprotein cholesterol (LDL-C) for prediction of coronary heart disease (CHD) remains controversial. Few studies have examined the association of various lipid markers with CHD in Asian populations. The aim of our study was to compare Apo B, non-HDL, LDL-C and other lipid markers as predictors of CHD in Chinese. We conducted a community-based prospective cohort study among 3,568 participants who had complete lipid measures and were free of cardiovascular disease history at the time of recruitment. 122 individuals developed CHD during a median of 13.6 years of follow-up. After adjustment for established cardiovascular risk factors, the relative risk of CHD in the highest quintile compared with the lowest quintile was 2.74 (95% confidence interval [CI], 1.45-5.19) for Apo B, 1.98 (95% CI, 1.00-3.92) for non-HDL-C, and 1.86 (95% CI, 1.00-3.49) for LDL-C (All tests for trend <0.05). In univariate analysis of individual lipid variables, Apo B had the highest receiver operator characteristic (ROC) curve area (0.63, 95% CI: 0.58-0.68) and the highest likelihood ratio chi-square value (26.6) in predicting CHD. When Apo B and non-HDL-C were mutually adjusted, only Apo B was predictive; the relative risk was 2.80 (95% CI, 1.31-5.96; P for trend= 0.001), compared with 1.09 (95% CI, 0.49-2.40; P=0.75) for non-HDL-C. Compared with the lowest risk profile, participants with the highest Apo B and total cholesterol (TC)/HDL-C values had more than 3-fold increased risk of developing CHD (RR = 3.21, 95% CI, 1.45-7.14). The data provide strong evidence that Apo B concentration was a better predictor of CHD than other lipid markers in Chinese.

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