title: Association of apolipoprotein B and nuclear magnetic resonance spectroscopy-derived LDL particle number with outcomes in 25 clinical studies: assessment by the AACC Lipoprotein and Vascular Diseases Division Working Group on Best Practices.
abstract: BACKGROUND
  The number of circulating LDL particles is a strong indicator of future cardiovascular disease (CVD) events, even superior to the concentration of LDL cholesterol. Atherogenic (primarily LDL) particle number is typically determined either directly by the serum concentration of apolipoprotein B (apo B) or indirectly by nuclear magnetic resonance (NMR) spectroscopy of serum to obtain NMR-derived LDL particle number (LDL-P).
  
  
  BACKGROUND
  To assess the comparability of apo B and LDL-P, we reviewed 25 clinical studies containing 85 outcomes for which both biomarkers were determined. In 21 of 25 (84.0%) studies, both apo B and LDL-P were significant for at least 1 outcome. Neither was significant for any outcome in only 1 study (4.0%). In 50 of 85 comparisons (58.8%), both apo B and LDL-P had statistically significant associations with the clinical outcome, whereas in 17 comparisons (20.0%) neither was significantly associated with the outcome. In 18 comparisons (21.1%) there was discordance between apo B and LDL-P.
  
  
  CONCLUSIONS
  In most studies, both apo B and LDL-P were comparable in association with clinical outcomes. The biomarkers were nearly equivalent in their ability to assess risk for CVD and both have consistently been shown to be stronger risk factors than LDL-C. We support the adoption of apo B and/or LDL-P as indicators of atherogenic particle numbers into CVD risk screening and treatment guidelines. Currently, in the opinion of this Working Group on Best Practices, apo B appears to be the preferable biomarker for guideline adoption because of its availability, scalability, standardization, and relatively low cost.
authors: Thom Cole Consulting, LLC, St. Louis, MO 63122, USA. tgchol@aol.com
authors: Thomas G
authors: TG
authors: Cole
authors: John H
authors: JH
authors: Contois
authors: Gyorgy
authors: G
authors: Csako
authors: Joseph P
authors: JP
authors: McConnell
authors: Alan T
authors: AT
authors: Remaley
authors: Sridevi
authors: S
authors: Devaraj
authors: Daniel M
authors: DM
authors: Hoefner
authors: Tonya
authors: T
authors: Mallory
authors: Amar A
authors: AA
authors: Sethi
authors: G Russell
authors: GR
authors: Warnick
mesh_terms: D001055:Apolipoproteins B / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001774:Blood Chemical Analysis / Q000379:methods* / Q000592:standards; D002318:Cardiovascular Diseases / Q000097:blood* / Q000517:prevention & control; D008078:Cholesterol, LDL / Q000097:blood*; D002986:Clinical Trials as Topic; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D009682:Magnetic Resonance Spectroscopy; D016896:Treatment Outcome
chemical_list: D001055:Apolipoproteins B; D015415:Biomarkers; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors