Apolipoproteins in the discrimination of atherosclerotic burden and cardiac function in patients with stable coronary artery disease.
OBJECTIVE
To compare the performance of apolipoproteins (Apo) and oxidized LDL against routine clinical lipid profiles in the discrimination of atherosclerotic burden and cardiac function in stable coronary artery disease (CAD) patients.


RESULTS
Using a cross-sectional approach, we measured oxidized LDL, Apo AI and B in 199 patients (34-81 years) with stable symptomatic CAD. The discrimination of (i) atherosclerotic burden (coronary atheroma scores, the number of diseased coronary vessels), and (ii) cardiac function [NYHA classification, left-ventricular systolic dysfunction (LVSD)] were judged using receiver operating characteristic (ROC) curves. The ratio of Apo AI to B was correlated to oxidized LDL (Spearman, r = 0.37, P < 0.001); however, oxidized LDL was unrelated to measures of cardiac function or CAD severity. Concentrations of Apo AI decreased from 1.38 to 1.20 g/L with increasing atheroma scores (P = 0.02), while triglyceride levels increased from 1.50 to 2.23 mmol/L (P = 0.016). High-density lipoprotein (HDL) cholesterol and Apo AI levels were higher among those with heart failure (P = 0.002), and increased ordinally with NYHA class (P = 0.005). On ROC analysis, reduced levels of Apo AI and HDL cholesterol were discriminators for patients in the upper quartile for atheroma score (P < 0.004). Raised indices of HDL were associated with heart failure (P < 0.002).


CONCLUSIONS
Apo AI levels are a consistent discriminator of atherosclerotic burden among patients with stable CAD. However, heart failure presents an element of confounding in the diagnostic and prognostic utility of Apo monitoring among these patients.
Patel
Jeetesh V
JV
Haemostasis Thrombosis and Vascular Biology Unit, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
Abraheem
Abraheem
A
Creamer
John
J
Gunning
Mark
M
Hughes
Elizabeth A
EA
Lip
Gregory Y H
GY
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016632:Apolipoprotein A-I / Q000097:blood*; D001055:Apolipoproteins B / Q000097:blood*; D019540:Area Under Curve; D008076:Cholesterol, HDL / Q000097:blood*; D016001:Confidence Intervals; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000473:pathology / Q000503:physiopathology*; D003331:Coronary Vessels / Q000473:pathology; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008077:Lipoproteins, LDL / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012044:Regression Analysis; D018709:Statistics, Nonparametric; D014280:Triglycerides / Q000097:blood; D016277:Ventricular Function, Left
D016632:Apolipoprotein A-I; D001055:Apolipoproteins B; D008076:Cholesterol, HDL; D008077:Lipoproteins, LDL; D014280:Triglycerides; C099252:oxidized low density lipoprotein