Apolipoprotein B but not LDL Cholesterol Is Associated With Coronary Artery Calcification in Type 2 Diabetic Whites

Abstract

OBJECTIVEEvidence favors apolipoprotein B (apoB) over LDL cholesterol as a predictor of cardiovascular events, but data are lacking on coronary artery calcification (CAC), especially in type 2 diabetes, where LDL cholesterol may underestimate atherosclerotic burden. We investigated the hypothesis that apoB is a superior marker of CAC relative to LDL cholesterol.RESEARCH DESIGN AND METHODSWe performed cross-sectional analyses of white subjects in two community-based studies: the Penn Diabetes Heart Study (N = 611 type 2 diabetic subjects, 71.4% men) and the Study of Inherited Risk of Coronary Atherosclerosis (N = 803 nondiabetic subjects, 52.8% men) using multivariate analysis of apoB and LDL cholesterol stratified by diabetes status.RESULTSIn type 2 diabetes, apoB was associated with CAC after adjusting for age, sex, and medications [Tobit regression ratio of increased CAC for 1-SD increase in apoB; 1.36 (95% CI 1.06–1.75), P = 0.016] whereas LDL cholesterol was not [1.09 (0.85–1.41)]. In nondiabetic subjects, both were associated with CAC [apoB 1.65 (1.38–1.96), P < 0.001; LDL cholesterol 1.56 (1.30–1.86), P < 0.001]. In combined analysis of diabetic and nondiabetic subjects, apoB provided value in predicting CAC scores beyond LDL cholesterol, total cholesterol, the total cholesterol/HDL cholesterol and triglyceride/HDL cholesterol ratios, and marginally beyond non-HDL cholesterol.CONCLUSIONSPlasma apoB, but not LDL cholesterol, levels were associated with CAC scores in type 2 diabetic whites. ApoB levels may be particularly useful in assessing atherosclerotic burden and cardiovascular risk in type 2 diabetes.

Association of APOB 3ʹ-VNTR alleles with type 2 diabetes, BMI, systolic and diastolic blood pressure

“…APOB protein is a component of chylomicrons, low-density lipoproteins (LDL), very low-density lipoproteins (VLDL), intermediate density lipoproteins (IDL) and functions as the main protein for transporting cholesterol to peripheral cells [1][2][3][4][5][6] . The plasma concentration of APOB protein reflects the total number of potentially atherogenic particles 2,4 and, therefore, is predictive of high risk of coronary heart disease that may not be otherwise detected from routine lipid profile 2,[7][8][9][10] .…”

“…The plasma concentration of APOB protein reflects the total number of potentially atherogenic particles 2,4 and, therefore, is predictive of high risk of coronary heart disease that may not be otherwise detected from routine lipid profile 2,[7][8][9][10] . High APOB protein level in blood is correlated with cerebrovascular and coronary artery diseases as well as increased risk of diabetes 1,3,11,12 . Variable number of tandem repeats (VNTRs), also known as minisatellites, comprise a significant portion (~3%) of the human genome 13 .…”

Triglycerides and Cardiovascular Disease

“…[203][204][205][206][207][208][209][210][211][212][213][214][215][216] In the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Study, an autopsy study of 15-to 34-year-old individuals who died of non-CVD causes, non-HDL-C was correlated with fatty streaks and raised lesions in the right coronary artery. 204 In adults, non-HDL-C correlates with coronary calcification 205,206 and CVD progression. 207 Although the relationship between non-HDL-C and CVD outcomes has been studied less extensively than the relationship between LDL-C, myocardial infarction, and cardiovascular death, there are prospective studies that have demonstrated strong relationships between non-HDL-C levels and CVD events in the absence 208 -210 or presence 211,212 of preexisting CVD or acute coronary syndrome.…”

Systematic Analysis of Risk Factors for Coronary Heart Disease in Japanese Patients with Type 2 Diabetes: A Matched Case-Control Study

“…Thus, the superiority of non-HDL-C over LDL-C as a CHD risk may be a common phenomenon beyond ethnic, anthropometric and metabolic diversities. Elevated non-HDL-C has been considered a predictor of the development of CHD because the amount of circulating atherogenic lipid particles can be more faithfully reflected in serum non-HDL-C than LDL values 25) , especially in patients with diabetes 26) . In other words, elevation of non-HDL-C is most likely causal for, rather than a simple marker of, CHD.…”