Abstract 11700: Fasting Apolipoprotein B48 is a Novel Marker for Residual Risks in Coronary Artery Disease During Intensive LDL-Lowering Therapy
Aims: The number of patients with coronary artery disease (CAD) has not been reduced despite intensive LDL-lowering therapies. The next therapeutic target beyond LDL cholesterol (LDL-C) remains unclear. Apolipoprotein B48 (apoB48) is not only a marker of postprandial hyperlipidemia but expected to be a novel marker for CAD. We assessed whether measurements of fasting serum apoB48 levels could predict CAD risk stratification.
Methods and Results: A total of 259 patients hospitalized for the therapeutic purpose of CAD or non-CAD were enrolled. Fasting serum levels of LDL-C and total apoB in the CAD group (n=188) were significantly lower than those in the non-CAD group (n=71), because of the LDL-lowering therapy with statins. (LDL-C; 97.3±26.2 vs. 115.2±32.9 mg/dl, p=0.001, total apoB; 74.2; 95%CI 71.8-76.6 vs. 82.7; 95%CI 77.7-87.7 mg/dl, p=0.0025). Thus, LDL-C or total apoB was not a clinical risk marker in the secondary prevention. On the other hand, fasting serum apoB48 levels were significantly higher in patients with the CAD group than in the non-CAD group (4.7; 95%CI 4.2-5.2, vs. 3.4; 95%CI 2.7-4.0 µU/ml, p<0.001), and this relation was independent of age, hypertension, dyslipidemia, diabetes mellitus, smoking, waist circumference, body mass index (BMI), metabolic syndrome, HDL-C, or medication including statins. Furthermore, apoB48 was higher in patients with first onset CAD (n=50) compared with those in the non-CAD patients (n=71) (4.4; 95%CI 3.6-5.3 µU/ml, vs. 3.4; 95%CI 2.7-4.0 µU/ml, p=0.028). In patients with low LDL-C (<100 mg/dl), apoB48 was higher by 2 folds in the CAD group (n=101) than in the non-CAD group (n=23) (4.6; 95%CI 4.0-5.2, vs. 2.2; 95%CI 1.4-3.0 µU/ml, p<0.001), and high apoB48 (>5.6µU/ml, arbitrarily determined by an ROC curve) was directly associated with CAD risks (odds ratio 6.28, 95%CI 1.75-22.47; p=0.005). In addition, ln(apoB48) showed a positive correlation with waist circumference, BMI, ln(triglyceride) and ln(HOMA-IR), and a negative correlation with HDL-C and eGFR.
Conclusion: Fasting serum apoB48 levels were associated with CAD independent of the LDL-C levels. Serum apoB48 serves as a novel marker and modulator in CAD, and therefore, it would be a therapeutic target in primary and secondary prevention of CAD.
- © 2011 by American Heart Association, Inc.