Fasting Insulin and Apolipoprotein B Levels and Low-Density Lipoprotein Particle Size as Risk Factors for Ischemic Heart Disease

Abstract

Context.-Epidemiological studies have established a relationship between cholesterol and low-density lipoprotein cholesterol (LDL-C) concentrations and the risk of ischemic heart disease (IHD), but up to half of patients with IHD may have cholesterol levels in the normal range. Objective.-To assess the ability to predict the risk of IHD using a cluster of nontraditional metabolic risk factors that includes elevated fasting insulin and apolipoprotein B levels as well as small, dense LDL particles. Design.-Nested case-control study. Setting.-Cases and controls were identified from the population-based cohort of the Québec Cardiovascular Study, a prospective study conducted in men free of IHD in 1985 and followed up for 5 years. Participants.-Incident IHD cases were matched with controls selected from among the sample of men who remained IHD free during follow-up. Matching variables were age, smoking habits, body mass index, and alcohol consumption. The sample included 85 complete pairs of nondiabetic IHD cases and controls. Main Outcome Measures.-Ability of fasting insulin level, apolipoprotein B level, and LDL particle diameter to predict IHD events, defined as angina, coronary insufficiency, nonfatal myocardial infarction, and coronary death. Results.-The risk of IHD was significantly increased in men who had elevated fasting plasma insulin and apolipoprotein B levels and small, dense LDL particles, compared with men who had normal levels for 2 of these 3 risk factors (odds ratio [OR], 5.9; 95% confidence interval [CI], 2.3-15.4). Multivariate adjustment for LDL-C, triglycerides, and high-density lipoprotein cholesterol (HDL-C) did not attenuate the relationship between the cluster of nontraditional risk factors and IHD (OR, 5.2; 95% CI, 1.7-15.7). On the other hand, the risk of IHD in men having a combination of elevated LDL-C and triglyceride levels and reduced HDL-C levels was no longer significant (OR, 1.4; 95% CI, 0.5-3.5) after multivariate adjustment for fasting plasma insulin level, apolipoprotein B level, and LDL particle size. Conclusion.-Results from this prospective study suggest that the measurement of fasting plasma insulin level, apolipoprotein B level, and LDL particle size may provide further information on the risk of IHD compared with the information provided by conventional lipid variables.

Apolipoprotein B, ratio of total cholesterol to HDL-C, and blood pressure in abdominally obese white and black American women

“…41 In the Quebec CardiovascuJournal of Human Hypertension lar Study, Lamarche et al 11,12,39,41 found ApoB to be better in assessing IHD risk than conventional lipids such as, LDL, HDL and TC/HDL. Thus, because it may provide information that would not be obtained from the conventional lipid-lipoprotein profile, ApoB may prove to be regarded as a more useful tool in the assessment of CVD risk.…”

“…11,12 Indeed, in multiple regression analysis, ApoB was found to have a much stronger association with ischaemic heart disease (IHD) than TC/HDL or lipoprotein-cholesterols. 12 In a statistical model that included traditional risk factors such as age, hypertension, smoking, diabetes and family history of CVD, ApoB was found to be the best metabolic predictor for IHD compared to TC/HDL or lipoprotein-cholesterols.…”

Bariatric surgery for pediatric extreme obesity: now or later?

“…73 Longitudinal studies have demonstrated that obesity in childhood and adolescence significantly increases the likelihood of hypertension, 74 hypercholesterolemia, 75 hypertriglyceridemia 76,77 and atherosclerotic disease 78,79 in young adulthood. Insulin resistance may be the important common denominator in multiple obesity-related comorbidities including T2DM, ischemic heart disease, 80 OSAS, 81 polycystic ovary syndrome, fatty liver disease 82 and even depression. An alarming one third to one half of all extremely obese adolescents currently meet diagnostic criteria for the metabolic syndrome.…”

The Quebec Heart Institute: 50 years of excellence in cardiology

“…In clinical research, cardiologists determined the diagnostic and prognostic value and limitations of the electrocardiogram during exercise stress testing (34)(35)(36). Finally, the team working on the Quebec Cardiovascular Study demonstrated that metabolic markers, such as insulin, small dense low-density lipoprotein cholesterol and apolipoprotein B, were significant predictors of cardiovascular events (37)(38)(39), and the simultaneous presence of these abnormalities was defined as the 'atherogenic metabolic triad'.…”