Can measurement of serum apolipoprotein B replace the lipid profile monitoring of patients with lipoprotein disorders?
BACKGROUND
Current clinical guidelines require that five indices (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and the total/HDL cholesterol ratio) be measured or calculated to assess the lipid-related risk of vascular disease. All five are also targets of therapy and therefore all must be measured initially and at follow-up. Considerable evidence indicates that apolipoprotein B (apo B) is a better index of reaching or not reaching treatment targets than total or LDL cholesterol.


METHODS
The objective of this study was to examine whether measurement of a single marker (apo B) led to the same categorization of risk as the traditional five indices (lipid profile). If both apo B and lipid profile indicated that the patient was either within or outside their respective treatment targets, the indices were considered concordant. If not, the indices were considered discordant. Concordance/discordance was examined in 215 patients at their first and last clinic visit.


RESULTS
Concordance was high in both higher (88% at the first and 92% at the last clinic visit) and lower (76% at the first and 78% at the last clinic visit) risk groups at both the initial and final visits. Discordance was virtually restricted to the group with hypertriglyceridemia with normal concentrations of apo B, a group in which little independent evidence points to any substantially increased risk of vascular disease.


CONCLUSIONS
These data raise the possibility that at least for high risk patients treated with statins, follow-up could be simplified and expenses reduced if only apo B were measured. They also raise the possibility that outcome might be improved if the therapeutic algorithm were simplified.
Miremadi
Saman
S
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, V6Z 1Y6, Canada.
Sniderman
Allan
A
Frohlich
Jiri
J
D001055:Apolipoproteins B / Q000097:blood*; D005500:Follow-Up Studies; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood*; D008055:Lipids / Q000097:blood*; D012306:Risk
D001055:Apolipoproteins B; D008055:Lipids