title: The risk of cardiovascular events with increased apolipoprotein CIII: A systematic review and meta-analysis.
abstract: BACKGROUND
  Apolipoprotein CIII (apoC-III) is an atherogenic protein found on HDL, VLDL and LDL.
  
  
  OBJECTIVE
  The objective of this study is to review the literature on the association of blood apoC-III level with cardiovascular events and the dose-response relationship for this association.
  
  
  RESULTS
  MEDLINE, EMBASE, BIOSIS, CINAHL, Clinicaltrials.gov, grey-literature sources, contact with investigators, and reference lists of studies, without language restrictions, were reviewed. Twelve studies (5 retrospective and 7 prospective) with a total of 3163 cases of cardiovascular events met inclusion criteria for this systematic review. The pooled standardized mean difference showed significantly higher levels of apoC-III in the non-HDL fraction of plasma (representing apoC-III in VLDL and LDL) in those with cardiovascular disease compared with controls; no difference for apoC-III levels in HDL; and, a trend toward higher total plasma apoC-III in the cases. Pooled risk estimates from the meta-analysis were 2.48 (1.48-4.32; non-HDL apoC-III), 1.09 (0.65-1.82; HDL apoC-III), and 1.33 (1.07-1.66; total apoC-III) for a cardiovascular event with a 5-mg/dL increase in apoC-III.
  
  
  CONCLUSIONS
  The current body of literature includes several methodologically sound studies that together provide consistent evidence for an association of cardiovascular events with blood apoC-III level in total plasma or in VLDL and LDL. More data are needed to determine importance of levels of apoC-III in specific lipoproteins for cardiovascular risk assessment and management and to elucidate the interaction between triglycerides and apoC-III in relation to risk of cardiovascular disease.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Froedtert Memorial Hospital, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: mcwvb@post.harvard.edu.
authors.forename: Moritz C
authors.initials: MC
authors.lastname: Wyler von Ballmoos
authors.affiliation: Department of Internal Medicine I, Comprehensive Heart Failure Center, University of Würzburg, Bavaria, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Haring
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Frank M
authors.initials: FM
authors.lastname: Sacks
mesh_terms: D053305:Apolipoprotein C-III / Q000097:blood*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000473:pathology; D006801:Humans; D015228:Hypertriglyceridemia / Q000097:blood* / Q000473:pathology; D008075:Lipoproteins, HDL / Q000097:blood; D008079:Lipoproteins, VLDL / Q000097:blood; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood
chemical_list: D053305:Apolipoprotein C-III; D008075:Lipoproteins, HDL; D008079:Lipoproteins, VLDL; D014280:Triglycerides
keywords: Atherosclerosis; Cardiovascular risk; Epidemiology; Lipoprotein