Value of HDL Cholesterol, Apolipoprotein A-I, Lipoprotein A-I, and Lipoprotein A-I/A-II in Prediction of Coronary Heart Disease

Abstract

on behalf of the PRIME Study Group* Objective-We have examined the association between the incidence of coronary heart disease (CHD) and plasma high density lipoprotein (HDL) cholesterol, apolipoprotein A-I (apoA-I), and 2 HDL fractions, lipoprotein A-I and lipoprotein A-I:A-II. Methods and Results-These parameters were measured in subjects recruited in France and in Northern Ireland in the Prospective Epidemiological Study of Myocardial Infarction (PRIME) Study, a prospective cohort study. Among the subjects free of CHD on entry, 176 in France and 113 in Northern Ireland suffered an ischemic attack (CHD patients) during the 5-year follow-up, whereas 6612 French and 2172 Northern Irish men showed no CHD symptoms (CHD-free subjects). All 4 HDL parameter levels were lower in CHD patients than in CHD-free subjects. After the cohort was divided into quintiles based on the distribution of HDL parameter levels, a significant (PϽ0.0001) linear increase in relative risk was observed for each HDL parameter level. However, regression logistic analyses showed that apoA-I was the strongest predictor (more powerful than HDL cholesterol) and that lipoprotein A-I and lipoprotein A-I:A-II did not supplement apoA-I in predicting CHD. Conclusions-Among the parameters related to HDL, apoA-I appears to be the strongest independent risk factor. Key Words: prospective study Ⅲ apolipoprotein A-I Ⅲ lipoprotein A-I Ⅲ coronary heart disease C oronary heart disease (CHD) is one of the main causes of premature death in industrialized countries, 1,2 and its prevalence has been increasing in developing countries. However, reported CHD mortality rates differ from one industrialized country to another. 3 In particular, the attack rates of myocardial infarction (MI) and CHD death present a north-south geographical gradient in Western Europe; for instance, the risk in Northern Ireland is twice as high as the risk in France. Differences in conventional risk factors (total cholesterol, blood pressure, and cigarette smoking) do not fully explain this difference in the incidence between northern and southern countries. 4 A multicenter case-control study, Etude CasTémoins sur l'Infarctus du Myocarde (ECTIM), comparing MI survivors and CHD-free subjects in Northern Ireland and in France investigated the hypothesis that besides the classic lipid risk factors, such as LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C), other factors, particularly lipoprotein particles, might contribute to an explanation for the geographical contrast in the disease. 5 Lipoprotein particles can be characterized by their apolipoprotein content and constitute separate metabolic pools. 6 Plasma lipoproteins are composed of a mixture of such particles, the plasma levels of which can be measured by using a combination of polyclonal and monoclonal antibodies. 7 Concentrations of LpA-I, which contain apoA-I but not apoA-II, proved to be of interest in comparing MI incident CHD cases with CHD-free control subjects in the ECTIM Study. A high-risk profile, partially characterized...

Hypertriglyceridemic waist and 7.5-year prospective risk of cardiovascular disease in asymptomatic middle-aged men

“…Hypertriglyceridemic waist and CVD risk in men S Czernichow et al Infarction (PRIME). 29 More recently, in the INTERHEART Study, a case-control study based on more than 29 000 subjects from 52 countries, apo-B/A1 ratio was associated with a 3.87-fold (3.39-4.42) increased risk of acute myocardial infarction after adjustment for age, sex and smoking. 21 Similar results were observed in the prospective AMORIS Study, with fatal myocardial infarction as outcome.…”

The relationship between lipoprotein(a) and coronary artery disease, as well as its variable nature following myocardial infarction

“…Total cholesterol (TC) and triglyceride (TG) analyses were carried out with enzymatic methods using the cholesterol enzymatique color II reactive and triglycerides enzymatique trinder II reactive (Biotrol, Paris). High-density lipoproteins (HDL-C) quanti cation was performed with CHOLHDL (Mg-dextran sulfate) reactive (Sclavo, Sovicille, Italy) via enzymatic measurement of the remaining cholesterol in the supernatant following precipitation of very-low-density lipoprotein (VLDL) and LDL-C. e Friedewald formula was used to determine VLDL and LDL-C values: [10]. Blood samples obtained for serum Lp(a) measurement were separated from the serum by centrifugation for 30 min, and then were stored in a deep freezer at -80°C.…”

“…Several studies have clearly shown a correlation between lipoprotein lipid fractions and CAD [7][8][9][10]. e results of two studies on the relationship between Lp(a) levels and CAD report con icting information [7,8].…”

Structural Plasticity of Cholesteryl Ester Transfer Protein Assists the Lipid Transfer Activity

“…Coronary heart disease (CHD) 2 is one of the prime causes of an increase in the mortality rate worldwide. Over the past few years, various epidemiological studies have provided ample evidence that increased levels of HDL, by transporting cholesterol from atherosclerotic plaques to liver for excretion, can arrest the progression of CHD (1,2).…”

“…Over the past few years, various epidemiological studies have provided ample evidence that increased levels of HDL, by transporting cholesterol from atherosclerotic plaques to liver for excretion, can arrest the progression of CHD (1,2). Subsequent preclinical studies on overexpression of apolipoprotein A-I (apoA-I), the major protein constituent of HDL, have reported significant reduction in CHD risk (3,4).…”