Risk factors for peripheral atherosclerosis. Retrospective evaluation by stepwise discriminant analysis.

Abstract

To evaluate the optimal discriminators for peripheral atherosclerosis, we studied retrospectively 49 male patients and 39 male controls between 40 and 60 years of age. In addition to hypertension, cigarette smoking, diabetes mellitus, and hyperuricemia, we determined the most common tipids, lipoproteins, and apolipoproteins. Highly significant differences of median values between patients and controls in decreasing order of magnitude were recorded for apo A-ll/apo B, apo A-l/apo B, apo B, total cholesterol, and LDL-cholesterol. A retrospective classification of patients and controls under optimal conditions with one variable (apo A-l/apo B) yielded an error rate of 25%. We found that apolipoproteins were better discriminators for peripheral atherosclerosis than were liplds or lipoprotein lipids. The application of a linear regression discriminant analysis including all 29 variables greatly decreased the rate of error and increased the sensitivity and specificity of the classification. From 2 29 possible models, we used an economic selection strategy to sort out those which either gave the best segregation or were considered the most practicable. The optimal model with 14 variables gave an error rate of less than 5% for the group studied. Suboptimal models yielded error rates between 13% and 18%. We conclude that a mathematical treatment of laboratory data which includes lipid parameters in addition to apolipoprotein values can improve the classification of peripheral vascular atherosclerosis. (Arteriosclerosis 3:57-63, January/February 1983)

Apoproteins B and A-I and coronary artery disease in humans.

“…53 The role of apoproteins D and E, 54 and the Lp(a) lipoprotein in relation to apo B and apo A-l and A-ll and their interaction in the genesis of atherosclerosis is as yet unknown.…”

Effect of Fenofibrate on Uric Acid Metabolism in Japanese Hyperlipidemic Patients

“…It is not clear whether hyperuricemia is one of the independent risk factors and the reduction of serum uric acid concentrations improves the prognosis of patients with metabolic syndromes. The serum uric acid level is, however, at a good indicator of severity and prognosis of such patients with metabolic syndromes (9)(10)(11)(12)(13). Patients with hyperuricemia caused by metabolic syndrome have a large number of metabolic abnormalities and need several kinds of medicines if they attempt to treat each problem independently.…”

Increased apoB/apoA-I Ratio is Predictive of Peripheral Arterial Disease in Initially Healthy 58-Year-old Men during 8.9 Years of Follow-up

“…[22][23][24][25][26] These studies have, in general, shown that apoA-I levels are lower and that apoB levels are most often higher in patients with PAD. Also, 1 retrospective case-control study showed that cases with PAD had increased apoB/apoA-I ratio compared to controls.…”

“…Also, 1 retrospective case-control study showed that cases with PAD had increased apoB/apoA-I ratio compared to controls. 26 Furthermore, it has been shown that apoB, rather than cholesterol, is an independent risk factor for development of PAD in smokers. 22 Results from the Apolipoprotein-related Mortality Risk (AMORIS) study 7 with 170 000 Swedish individuals showed that apoB was a better marker of cardiovascular risk than LDL, especially in individuals with desirable levels of LDL, regardless of sex.…”

“…Results from these studies, which were performed in different subgroups, have shown that either high levels of apoB or low levels of apoA-I increase the risk of PAD or peripheral artery insufficiency. [22][23][24][25][26] A casecontrol study in 88 male participants performed by Pilger et al observed that cases with PAD had significantly higher levels of apoB than the controls, and although the apoA-I levels were only slightly and nonsignificantly lower in the cases, apoB/apoA-I ratios were much lower in controls than in cases, 26 and a study by O'Neal et al performed in diabetic and nondiabetic participants with peripheral vascular disease showed that high levels of apoB and low levels of apoA-I characterized the participants with peripheral vascular disease compared with participants without peripheral vascular disease in the nondiabetic group. 24 Even though the apoB and A-I are presented separately in that study and not expressed as apoB/apoA-I ratio, it is likely that the ratio will be increased in participants with peripheral vascular disease compared to participants without the disease when calculated.…”