The risk of developing cardiovascular disease is strongly associated with “bad” LDL cholesterol. A large study by scientists at the Karolinska Institutet now shows that two proteins that transport cholesterol particles in the blood provide early and reliable information about the risks. The researchers are now advocating the introduction of new guidelines for detecting heart risk and say the findings could pave the way for early treatment, which could help reduce morbidity and mortality rates.
Cardiovascular disease is the most common cause of death worldwide and includes a wide range of conditions, such as stroke and myocardial infarction with atherosclerosis in different organs of the body. In many cases, the disease can be prevented and stopped with lifestyle changes and lipid-lowering treatments using statins and other methods.
The data typically used to assess elevated heart risk are benchmarks for “bad” LDL cholesterol. In some medical conditions, other types of fat particles are also measured along with apolipoproteins, which carry cholesterol in the blood. International guidelines on cardiovascular disease recommend using apolipoprotein apoB, which carries “bad” cholesterol, as an alternative risk marker for people with type 2 diabetes, overweight (high BMI) and lipid levels. very high blood.
However, recent research has indicated the importance of also taking into account the apolipoprotein apoA-1, which carries the âgoodâ protective and anti-inflammatory HDL cholesterol. Calculating the apoB / apoA-1 ratio gives a risk quotient reflecting the balance between the “bad” particles of fat that accelerate atherosclerosis and the “good” protective particles of apoA-1 that stop the process.
In this study, researchers analyzed the link between cardiovascular disease and apoB / apoA-1 values ââin more than 137,000 Swedish men and women aged 25 to 84. The individuals were followed for 30 years, during which 22,000 suffered some form of cardiovascular event. The analytical methods are simple, inexpensive, and safe, and do not require pre-testing on an empty stomach, as is the case with LDL and non-HDL testing. By basing their study on a large database (AMORIS), the researchers linked the lab tests to several registries of clinical diagnoses.
The results show that the higher the apoB / apoA-1 value, the higher the risk of myocardial infarction, stroke and the need for coronary surgery. The study also showed that the risk was magnified in the presence of low protective levels of apoA-1. “
GÃ¶ran Walldius, Principal Author and Emeritus Professor, Institute of Environmental Medicine, Epidemiology Unit, Karolinska Institutet
People with the highest apoB / apoA-1 values ââhad a 70% higher risk of severe cardiovascular disease and an almost triple risk of non-fatal myocardial infarction compared to those with apoB / apoA values. -1 the weakest. Individuals with the highest risk quotient were also more affected by severe cardiovascular disease many years earlier than individuals with the lowest apoB / apoA-1 values.
The relationship has been observed in men and women and the elevated levels could be detected as early as 20 years before the onset of cardiovascular disease.
âEarly preventive treatment and information about cardiovascular risk are, of course, important in enabling individuals to manage their risk situation,â says Walldius. âEarly treatment can also reduce the financial burden on public health services. “
Overall, the results indicate that the apoB / apoA-1 ratio is a better marker for identifying more individuals at risk for future cardiovascular disease than the apoB method alone, according to the researchers.
“It should be possible to introduce cut-off values ââfor apoB, apoA-1 and the apoB / apoA-1 ratio in the new guidelines in addition to the current guidelines on the detection and treatment of dyslipidemia,” said declared Walldius.
The study was funded by the Gunnar and Ingmar Jungner Foundation for Laboratory Medicine.
Walldius, G., et al. (2021) Long-term risk of a major cardiovascular event (MACE) by apoB, apoA-1 and the apoB / apoA-1 ratio – Swedish AMORIS cohort experience: A cohort study. PLoS medicine. doi.org/10.1371/journal.pmed.1003853.