Apolipoprotein Concentrations During Treatment and Recurrent Coronary Artery Disease Events

Abstract

Abstract-The effect of untreated total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) as cardiovascular risk factors in both primary and secondary prevention has been extensively investigated. The predictive value of on-treatment lipid and apolipoprotein levels on subsequent cardiovascular events is as yet uncertain. Eight hundred forty-eight patients (675 men and 173 women) with angiographically proven coronary artery disease (CAD) who received effective statin therapy (Ն30% decrease of baseline TC) were studied. We analyzed the predictive value of on-treatment levels of TC, LDL-C, triglycerides (TG), apolipoprotein A-I (apoA-I) and apolipoprotein B (apoB) on subsequent myocardial infarction (MI) and all cause mortality. On-treatment LDL-C levels were 2.55Ϯ0.55 mmol/L and 2.58Ϯ0.62 mmol/L for men and women respectively. Age-adjusted Cox regression analysis showed that only on-treatment apoA-I was predictive for future CAD events in both men and women, whereas on-treatment HDL-C was exclusively predictive in women. On-treatment apoB levels were predictive for recurrent CAD events in the total population but not after separate analysis for men and women. On-treatment levels of TC, LDL-C, and TG did not predict subsequent events. Multivariate analysis showed that on-treatment apoA-I and apoB were the only significant predictors for future cardiovascular events. On-treatment levels of TC, LDL-C, and TG were no longer associated with increased risk of recurrent cardiovascular events in CAD patients treated to target levels, which justifies the current guidelines. However, on-treatment levels of apoB and in particular apoA-I (and HDL-C in women) were significantly predictive for MI and all-cause mortality and may therefore be more suitable for cardiovascular risk assessment in this population. (Arterioscler Thromb Vasc

Effect of Atorvastatin on High-Density Lipoprotein Apolipoprotein A-I Production and Clearance in the New Zealand White Rabbit

“…5 Numerous studies have identified HDL cholesterol and its major protein component, apolipoprotein A-I (apoA-I), as having a direct protective role against the development of CAD. 5,6 There has been tremendous interest in the effect of HMG-CoA reductase inhibitors on HDL metabolism, with reports that the various agents in this class appear to have quantitatively different effects on HDL levels. 3,7,8 Atorvastatin, in contrast to some other statins, appears to lose its HDL-raising effect at higher drug doses.…”

Correlação entre os níveis plasmáticos de apolipoproteínas A-I e B e o perfil lipídico em indivíduos com e sem diabetes mellitus tipo 2 e hipertensão arterial

“…As partículas aterogênicas de LDL e os remanescentes de quilomícrons e lipoproteína de muito baixa densidade (VLDL) apresentam uma molécula de ApoB como parte da estrutura protéica. Por isso, a concentração plasmática de ApoB tem sido considerada um melhor representante das partículas aterogênicas ou do colesterol não-HDL, e alguns estudos têm demonstrado que níveis plasmáticos elevados de ApoB podem ser um valioso preditor de DAC (26) .…”

Atherosclerotic plaque imaging by PET/CT; can inactive, active and mixed plaques be discerned?

“…Rupture of atherosclerotic plaques and formation of thrombi are the primary mechanisms of myocardial infarction or cerebrovascular accidents. Atherosclerosis is therefore a dynamic inflammatory disorder and the biological composition and inflammatory state of an atherosclerotic plaque, rather than the degree of stenosis or its size, are the major determinants of acute clinical events [1,2]. Noninvasive techniques to detect vulnerable atherosclerotic plaque are critically needed.…”