title: Apolipoproteins do not add prognostic information beyond lipoprotein cholesterol measures among individuals with obesity and insulin resistance syndromes: the ARIC study.
abstract: OBJECTIVE
  There are conflicting guidelines regarding the measurement of apolipoproteins (apoB, apoA-1), in addition to standard lipoprotein cholesterol measures, for cardiovascular risk assessment among individuals with obesity or insulin resistance syndromes. This study aims to assess whether apolipoprotein assessments add prognostic information regarding coronary heart disease (CHD) risk beyond standard lipoprotein cholesterol measurements among individuals with obesity, diabetes, and the metabolic syndrome.
  
  
  RESULTS
  We followed 9026 participants in the Atherosclerosis Risk in Communities (ARIC) study without cardiovascular disease at baseline (visit 4, 1996-99). We compared the associations of apoB, apoA-1, and their respective lipoprotein cholesterol measures with incident CHD events among individuals with and without obesity, the metabolic syndrome, or diabetes. Over a median follow up of 10.1 years, there were 903 CHD events. Among participants with obesity, the top quintiles of apoB (HR 2.00, 95% CI 1.40-2.85 compared with the bottom quintile) and the apoB/apoA-1 ratio (HR 2.47, 95% CI 1.53-4.01) did not demonstrate stronger associations with CHD than the top quintiles of non-high-density-lipoprotein cholesterol (non-HDL-C) (HR 2.54, 95% CI 1.65-3.89) and the ratio of non-HDL-C/HDL-C (HR 4.28, 95% CI 2.29-8.03). Analogous findings were seen among patients with diabetes and the metabolic syndrome. In models adjusted for non-HDL-C and HDL-C, apoB (p = 0.94) and apoA-1 (p = 0.55) were not significantly associated with CHD events among those with obesity, in contrast to non-HDL-C and HDL-C (p = 0.02 for both).
  
  
  CONCLUSIONS
  Among individuals with obesity and insulin resistance syndromes, apolipoproteins did not provide prognostic information regarding CHD risk beyond that provided by non-HDL-C and HDL-C.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
authors.forename: Chiadi E
authors.initials: CE
authors.lastname: Ndumele
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Brad
authors.initials: B
authors.lastname: Astor
authors.affiliation: Section of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
authors.affiliation: Divisions of Cardiovascular Disease and Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Samia
authors.initials: S
authors.lastname: Mora
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Emma K
authors.initials: EK
authors.lastname: Williams
authors.affiliation: Section of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Ron C
authors.initials: RC
authors.lastname: Hoogeveen
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: A Richey
authors.initials: AR
authors.lastname: Sharrett
authors.affiliation: Section of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA coresh@jhu.edu.
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
mesh_terms: D001053:Apolipoproteins / Q000097:blood*; D002784:Cholesterol / Q000097:blood*; D015331:Cohort Studies; D003327:Coronary Disease / Q000097:blood / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007333:Insulin Resistance; D008074:Lipoproteins / Q000097:blood*; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood* / Q000150:complications; D008875:Middle Aged; D009765:Obesity / Q000097:blood* / Q000150:complications; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D001053:Apolipoproteins; D008074:Lipoproteins; C030104:lipoprotein cholesterol; D002784:Cholesterol
keywords: Apolipoproteins; cholesterol; diabetes mellitus; insulin resistance; lipids; obesity