Lipid Markers Called Lipoproteins Can Predict Cardiovascular Events

Dyslipidemias are a major risk factor for the development of cardiovascular (CV) atherosclerotic diseases. Low-density lipoprotein cholesterol (LDL) is considered the major causative lipid fraction, and lowering it reduces the risk of CV events. 

LDL is therefore the preferred risk marker in the international guidelines. But with the newly updated guidelines, attention is also recommended for lipids other than high-density lipoprotein cholesterol (HDL) as well as apolipoprotein B (apoB) in certain medical conditions. 

ApoB has gained support as a risk marker in a UK Biobak study. The potentially atherogenic cholesterol-containing lipoprotein particles very-low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), and low-density lipoprotein (LDL) are transported in blood by apoB. The protective high-density lipoprotein (HDL) particles are transported by apoA-1. This is because both apoB and apoA-1 can penetrate the arterial wall.

New Study Findings 

A recently published study in the journal PLOS Medicine had found that those with the highest levels of apoB and lowest levels of apoA-1 are almost 3 times more likely to have a heart attack than those with lower ratios of apoB to apoA-1. 

Research has shown that the ratios of both apoB and apoA-1 have links to an increased risk of heart attack and stroke.

In the study, researchers in Sweden, investigated the link between these two apolipoproteins and the incidence of nonfatal heart attacks, strokes and cardiovascular mortality. 

“The results show that the higher the apoB/apoA-1 value, the greater the risk of myocardial infarction, stroke, and need for coronary surgery,” says Prof. Göran Walldius, senior author and professor emeritus at the Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet.

“The study also showed that the risk was amplified in the presence of low protective levels of apoA-1.”

The researchers obtained their data from the AMORIS cohort, a database that contains health records including blood and urine sample analyses from individuals in Sweden from 1985 to 1996. 

From their analysis, the researchers found that the higher the apoB level and the lower the apoA-1 levels were, the greater the cardiovascular risk among both men and women.

Those with the highest apoB/apoA-1 values were almost three times more likely to have a heart attack. They were also at nearly a 70% greater risk of a major cardiovascular event and almost 40% more likely to die from cardiovascular causes.

The researchers also found that the apoB/apoA-1 ratio could predict cardiovascular events as early as 20 years before they happened. 

After adjusting for cholesterol, triglycerides, glucose, sex, and socioeconomic status, the results remained significant.


Göran Walldius, et al. Long-term risk of a major cardiovascular event by apoB, apoA-1, and the apoB/apoA-1 ratio—Experience from the Swedish AMORIS cohort: A cohort study.  PLOS Med .2021.

Annie Lennon (2021, Dec 7). Lipid markers predict cardiovascular events 20 years before time. Medical News Today. Retrieved from: 

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