Lipoprotein Biomarkers and Risk of Cardiovascular Disease: A Laboratory Medicine Best Practices (LMBP) Systematic Review

Abstract

Background Controversy exists about the incremental utility of nontraditional lipid biomarkers [e.g., apolipoprotein (apo) B, apo A-I, and non-HDL-C] in improving cardiovascular disease (CVD) risk prediction when added to a conventional model of traditional risk factors (e.g., total cholesterol, LDL cholesterol, HDL cholesterol, sex, age, smoking status, and blood pressure). Here we present a systematic review that was conducted to assess the use of nontraditional lipid biomarkers including apo B, apo A-I, apo B/A-I ratio, and non-HDL-C in improving CVD risk prediction after controlling for the traditional risk factors in populations at risk for cardiovascular events. Content This systematic review used the Laboratory Medicine Best Practices (LMBP™) A-6 methods. A total of 9 relevant studies published before and including July 2015 comprised the evidence base for this review. Results from this systematic review indicated that after the adjustment for standard nonlipid and lipid CVD risk factors, nontraditional apolipoprotein biomarkers apo B (overall effect = relative risk: 1.31; 95% CI, 1.22–1.40; 4 studies) and apo B/apo A-I ratio (overall effect = relative risk: 1.31; 95% CI, 1.11–1.38; 7 studies) resulted in significant improvement in long-term CVD risk assessment. Summary Available evidence showed that nontraditional lipid biomarkers apo B and apo B/apo I ratio can improve the risk prediction for cardiovascular events after controlling for the traditional risk factors for the populations at risk. However, because of insufficient evidence, no conclusions could be made for the effectiveness of apo A-I and non-HDL-C lipid markers to predict the CVD events, indicating a need for more research in this field.

Non-high-density lipoprotein cholesterol predicts nonfatal recurrent myocardial infarction in patients with ST segment elevation myocardial infarction

“…Our results are in accord with those of a previous study that did not detect a relationship between non-HDL and cardiovascular disease outcomes in a cohort of patients with prevalent coronary artery disease [42]. However, a recent systematic review of studies, including patients with multiple risk factors for cardiovascular disease, found no evidence that non-HDL markers predict the occurrence of cardiovascular events [43]. Therefore, there is a need for more research in this field.…”

Dyslipidemias and Their Association With Chronic Non-Infectious Diseases (Meridian-Ro Study)

“…Наиболее крупные исследования AMORIS и INTER-HEART показали важную роль АпоВ в развитии не только неблагоприятных сердечно-сосудистых исходов, но и атеросклероза [32][33][34][35]. Эти данные подтверждаются и рядом исследований, завершившихся О р и г и н а л ь н ы е и с с л е д о в а н и я в последние годы [10,26,[36][37][38]. В нашей работе при анализе неблагоприятных исходов ХНИЗ также было показано, что их наилучшим предиктором был АпоВ > 180 мг/дл.…”

Management and Follow-Up of Dyslipidemia in Primary Health Care Setting

“…Other biomarkers include lipoproteins and C-reactive protein, and have evidence that they are not effective to be added to risk assessment tools. In conclusion, no solid evidence is available now to promote using biomarkers during the management of CVD [6] .…”