Apolipoprotein A-I versus HDL cholesterol in the prediction of risk for myocardial infarction and stroke.
OBJECTIVE
To compare the potential of high-density lipoprotein (HDL) cholesterol and apolipoprotein (apo) A-I, the major protein in HDL particles, in predicting cardiovascular risk. Pros and cons for using these risk markers are discussed.


RESULTS
Both HDL cholesterol and apoA-I are in most clinical conditions antiatherogenic - the higher the values, the lower the cardiovascular risk. Methodological and physiological factors speak in favour of using apoA-I rather than HDL cholesterol as a marker of risk. In prospective risk studies and in lipid-lowering trials it has been shown that the apoB/A-I ratio, which reflects the cholesterol balance between all potentially atherogenic (apoB) and antiatherogenic lipoproteins (apoA-I), is a better risk marker than low-density lipoprotein cholesterol, HDL cholesterol and lipid ratios in predicting cardiovascular risk and response to lipid lowering induced by statins. Practical advantages speak in favour of using apoB and apoA-I - fasting is not needed to analyze and interpret the values of apoB and apoA-I.


CONCLUSIONS
New guidelines should be developed in which target values for apoB and apoA-I are defined to enable the use of these new strong risk markers/factors in clinical practice.
Walldius
Göran
G
King Gustaf V Research Institute, Karolinska Institute, Stockholm, Sweden. goran.walldius@astrazeneca.com
Jungner
Ingmar
I
D016632:Apolipoprotein A-I / Q000097:blood* / Q000502:physiology; D015415:Biomarkers / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood* / Q000502:physiology; D006801:Humans; D009203:Myocardial Infarction / Q000097:blood*; D012307:Risk Factors; D020521:Stroke / Q000097:blood*
D016632:Apolipoprotein A-I; D015415:Biomarkers; D008076:Cholesterol, HDL