Apolipoprotein B: An Indicator for Cardiovascular Risk Assessment, study says

Italy: A recent study published in Pharmacological Research has shown a strong causal association between the number of LDL particles (i.e. apoB level) and ASCVD (atherosclerotic cardiovascular disease) than the cholesterol content (i.e. LDL-C level).

"Routine measurement of both apolipoprotein B (apoB) and LDL-cholesterol is of utmost importance to properly estimate global CV risk and to determine the 'residual' ASCVD risk in patients receiving therapy, and to monitor therapeutic effectiveness, given the causal role of LDL-cholesterol in ASCVD development," the researchers wrote in their study.

The prevention and management of atherosclerotic cardiovascular disease (ASCVD) heavily rely on accurate risk assessment. Recent insights by Federica Galimberti and team suggest that apoB could offer a more comprehensive understanding of ASCVD risk than traditional methods. ApoB's role in indicating the number of atherogenic particles within the arterial lumen, irrespective of particle density, highlights its potential significance in risk evaluation, particularly in specific patient groups.

The subendothelial retention of apolipoprotein B-containing lipoproteins initiates pro-atherosclerotic processes, making it a pivotal step in ASCVD development. Recent genetic and clinical evidence underscores the importance of the number of circulating atherogenic particles trapped in the arterial lumen rather than just their lipid content. Since each low-density lipoprotein (LDL) particle carries one apoB molecule, it's proposed that the total number of atherogenic lipoproteins, represented by apoB levels, could provide a more accurate insight into cardiovascular risk.

ApoB emerges as a robust proxy for assessing ASCVD risk, especially in specific patient subsets. Unlike traditional methods that often focus on LDL-cholesterol levels, apoB accounts for the total number of atherogenic lipoproteins, disregarding particle density and heterogeneity of particle cholesterol content. This makes it particularly relevant in patients with diabetes mellitus, multiple cardiometabolic risk factors (such as obesity, metabolic syndrome, insulin resistance, and hypertension), high triglyceride levels, and very low LDL-cholesterol levels.

Recognizing the pivotal role of LDL-cholesterol in ASCVD, experts emphasise the need for both LDL-cholesterol and apoB measurements to accurately estimate cardiovascular risk. This approach is especially crucial in determining the overall risk profile and assessing the 'residual' risk of ASCVD in patients under therapy. Monitoring the effectiveness of therapeutic interventions also gains precision through this comprehensive assessment.

The novel perspective on apoB emphasises the importance of personalised and precise risk assessment in the realm of cardiovascular health. By accounting for the total number of atherogenic particles, apoB could enhance the identification of individuals at risk, enabling targeted preventive measures and therapeutic strategies. Routine measurement of both LDL-cholesterol and apoB is deemed essential in capturing the nuanced complexities of cardiovascular risk, ultimately contributing to improved patient care and outcomes.

Reference:

Galimberti, F., Casula, M., & Olmastroni, E. (2023). Apolipoprotein B compared with low-density lipoprotein cholesterol in the atherosclerotic cardiovascular diseases risk assessment. Pharmacological Research: The Official Journal of the Italian Pharmacological Society, 195(106873), 106873. https://doi.org/10.1016/j.phrs.2023.106873