Discordantly normal ApoB relative to elevated LDL-C in persons with metabolic disorders: A marker of atherogenic heterogeneity

Alexander C Razavi; Lydia A Bazzano; Jiang He; Marie Krousel-Wood; Kirsten S Dorans; Michael A Razavi; Camilo Fernandez; Seamus P Whelton; Tanika N Kelly

doi:10.1016/j.ajpc.2021.100190

Discordantly normal ApoB relative to elevated LDL-C in persons with metabolic disorders: A marker of atherogenic heterogeneity

Am J Prev Cardiol. 2021 May 4:7:100190. doi: 10.1016/j.ajpc.2021.100190. eCollection 2021 Sep.

Authors

Alexander C Razavi^{1

2}, Lydia A Bazzano^{1

2}, Jiang He^{1

2}, Marie Krousel-Wood^{1

2}, Kirsten S Dorans², Michael A Razavi¹, Camilo Fernandez^{1

2}, Seamus P Whelton³, Tanika N Kelly^{1

2}

Affiliations

¹ Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, United States of America.
² Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America.
³ The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.

Abstract

Objective: A significant proportion of persons with metabolic syndrome (MetS), prediabetes, or type 2 diabetes (T2D) do not develop atherosclerotic cardiovascular disease (ASCVD).We sought to determine whether discordantly normal apolipoprotein B (ApoB) relative to elevated LDL-C may help to explain heterogeneity in ASCVD risk among persons with metabolic disorders.

Methods: There were 278 Bogalusa Heart Study participants with MetS (n=95), prediabetes (n=233), or T2D (n=31) and LDL-C ≥100 mg/dL who were free of carotid plaque at baseline (2001-02) and underwent carotid ultrasound at follow-up (2013-16). Multivariable modified Poisson regression estimated the long-term absence of carotid plaque for lower ApoB, continuously and categorically.

Results: Participants were on average 36.1 years old at baseline, 61.5% were women, and 31.7% were black. A total of 50.7% had discordantly normal ApoB (<90 mg/dL) and the mean ApoB and LDL-C concentrations were 91.6 mg/dL and 137.7 mg/dL, respectively. In addition to having higher HDL-C and lower triglyceride values, individuals with ApoB <90 were more likely to maintain persistent absence of plaque compared to those with ApoB ≥90 (73.1% versus 58.4%, p=0.01). Contrastingly, there was no significant difference in the proportion of individuals who remained free of plaque with increasing LDL-C (p=0.45). Independent of traditional risk factors including LDL-C, each 10 mg/dL lower ApoB (RR=1.11, 95% CI: 1.03-1.19) and ApoB <90 (RR=1.22, 95% CI: 1.00-1.43) were significantly associated with the persistent absence of carotid plaque.

Conclusions: One-half of young persons with metabolic disorders and elevated LDL-C had discordantly normal ApoB and a low burden of carotid atherosclerosis over 13 years, suggesting that ApoB better represents the atherogenic lipid burden compared to LDL-C in this patient population. These results suggest a utility for assessing whether routine ApoB measurement can improve ASCVD risk stratification in young persons with metabolic disorders who have high triglycerides and low HDL-cholesterol.

Keywords: Apolipoprotein-B; Low density lipoprotein cholesterol; Metabolic syndrome; Type 2 diabetes.

Abstract

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