Comparison of Laboratory Parameters as Risk Factors for the Presence and the Extent of Coronary or Carotid Atherosclerosis: the Significance of Apolipoprotein B to Apolipoprotein AII Ratio

Abstract

We compared several "new" risk factors (autoantibodies to oxidatively modified low density lipoprotein (LDL), sialic acid content of LDL, bilirubin and C-reactive protein) with "conventional" risk factors (apolipoprotein (apo) AI, AII and B, lipoprotein(a), triglycerides, and total, LDL and high density lipoprotein (HDL) cholesterol) for the presence and the extent of coronary or carotid atherosclerosis. Forty male patients with angiographically proven coronary atherosclerosis and 31 male patients with ultrasound-proven extracranial carotid atherosclerosis were compared to 40 age matched (53+/-5 years) healthy males as control subjects, with negative parental history of atherosclerosis, no clinical signs of systemic or organ-related ischemic disease and normal extracranial carotid arteries. The apo B/apo All ratio most powerfully indicated the presence and the extent of coronary or carotid atherosclerosis. Elevated lipoprotein(a) contributed significant additional information in the assessment of the atherosclerotic risk. Increase in C-reactive protein indicated the presence (but not the extent) of coronary or carotid atherosclerosis with a similar power as lipoprotein(a). Decreased values of total bilirubin indicated the presence of atherosclerosis only in smokers. Autoantibodies to oxidatively modified LDL additionally described the atherosclerotic process, but were less important than apolipoproteins, lipoprotein(a), C-reactive protein or bilirubin. Sialic acid content of LDL added no information to the parameters discussed above. We demonstrated that in male patients apolipoproteins, especially the apo B/apo All ratio, were better indicators of the presence and the extent of coronary or carotid atherosclerosis than C-reactive protein, bilirubin, autoantibodies to oxidatively modified LDL or sialic acid content of LDL.

Plasma Bilirubin and UGT1A1*28 Are Not Protective Factors Against First-Time Myocardial Infarction in a Prospective, Nested Case–Referent Setting

“…Medicated individuals had significantly lower bilirubin levels compared with those without medication. There was no evidence for a difference in myocardial infarction risk between the different UGT1A1 genotypes: The (TA) 6 /(TA) 7 distributions did not diverge between cases and referents, and lag time and sex subgroup analyses likewise failed to reveal any significant associations (Table 2). On the other hand, plasma bilirubin was lower in cases compared with referents, and analysis of risk associated with bilirubin level quartiles suggested a highly significant protective effect of the compound in univariate analysis (Table 3).…”

“…The genotypes for both referents and cases were in Hardy-Weinberg equilibrium. In addition to the common (TA) 6 and (TA) 7 genotypes, we also found 4 individuals with the (TA) 5 genotype and 1 individual with (TA) 8 , which were excluded from further analysis. The proportion of fasting samples did not differ between cases and referents.…”

“…17,18 As to the (TA) 7 genotype, 2 retrospective studies have failed to find a risk association, 19,20 whereas 1 study with prospective design found a strong association between (TA) 7 bearership and lower risk for cardiovascular disease, 21 whereas another prospective study found no evidence for lower risk for coronary heart disease. 22 The aim of our study was to evaluate how plasma bilirubin and the (TA) 7 genotype polymorphism influence the risk for first-ever myocardial infarction in a large, prospective, nested case-referent setting and to evaluate determinants of bilirubin levels.…”

A genome scan for loci influencing anti-atherogenic serum bilirubin levels

“…15 A small case-control study found decreased values of bilirubin indicative of the presence of atherosclerosis in smokers. 32 The Family Heart Study pointed to a gender-specific effect of bilirubin on CAD since it observed an association of borderline significance in males but not in females. 14 This is in accordance with our results showing only significant differences for bilirubin levels in males but not in females (Table 4) and with results from the prospective Framingham Offspring Study.…”

Elevated C-Reactive Protein Constitutes an Independent Predictor of Advanced Carotid Plaques in Dyslipidemic Subjects

“…13,14 An association between CRP and the presence and number of stenosed coronary vessels has been documented in coronary atherosclerosis. [15][16][17][18][19][20] With respect to carotid atherosclerosis, 2 studies have shown a positive association between serum CRP levels and the presence of carotid plaques. 20,21 In the Bruneck Study (Willeit et al 21 ), a significant relationship between CRP and early nonstenotic atherosclerosis (Յ40% narrowing of the lumen) was restricted to univariate analysis.…”