Apolipoproteins: the new prognostic indicator?

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Abstract
Accumulating evidence indicates that apolipoprotein (apo)B, apoA-I and, particularly, the apoB:apoA-I ratio are strong predictors of risk for coronary heart disease and of benefit in coronary heart disease prevention in lipid-lowering trials. For example, the Apolipoprotein related MOrtality RISk study showed that the apoB:apoA-I ratio was strongly related to increased risk for fatal myocardial infarction, and that plasma apoB and apoA-I levels and apoB:apoA-I ratio were better predictors of risk than levels of total cholesterol or triglycerides. Analysis of lipid variables in the Air Force/Texas Coronary Atherosclerosis Prevention Study population showed that baseline high-density lipoprotein cholesterol (HDL-C), apoA-I, apoB, low-density lipoprotein cholesterol (LDL-C):HDL-C ratio, total cholesterol:HDL-C ratio and apoB:apoA-I ratio significantly predicted first major acute event, whereas LDL-C and total cholesterol did not. For 1-year on-treatment values, only apoA-I, apoB and apoB:apoA-I ratio were significant predictors of a future coronary event. New statins can reduce substantially the apoB:apoA-I ratio. This is particularly evident for rosuvastatin (the latest addition to the class), which both decreases apoB and increases apoA-I. A number of conceptual and practical hurdles need to be overcome before apolipoprotein measurements can be incorporated into routine risk assessment.

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