van der Steeg Wim A, Boekholdt S Matthijs, Stein Evan A, El-Harchaoui Karim, Stroes Erik S G, Sandhu Manjinder S, Wareham Nicholas J, Jukema J Wouter, Luben Robert, Zwinderman Aeilko H, Kastelein John J P, Khaw Kay-Tee
Academic Medical Center, Amsterdam, The Netherlands.
Ann Intern Med. 2007 May 1;146(9):640-8. doi: 10.7326/0003-4819-146-9-200705010-00007.
An elevated apolipoprotein B-apolipoprotein A-I (apo B-apo A-I) ratio is a risk factor for future coronary artery disease (CAD). It is not known whether this ratio is better than traditional lipid values for risk assessment and prediction and whether it adds predictive value to the Framingham risk score.
To evaluate whether the apo B-apo A-I ratio is associated with future CAD events independent of traditional lipid measurements and the Framingham risk score and to evaluate the ability of this ratio to predict occurrence of future CAD.
Prospective, nested case-control study.
Norfolk, United Kingdom.
Apparently healthy men and women (45 to 79 years of age) in the European Prospective Investigation into Cancer and Nutrition-Norfolk. Cases (n = 869) were persons who developed fatal or nonfatal CAD. Controls (n = 1511) were persons without CAD who were matched for age, sex, and enrollment period.
Total cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride, apolipoprotein, and C-reactive protein levels were measured directly. Low-density lipoprotein (LDL) cholesterol values were calculated by using the Friedewald formula.
The apo B-apo A-I ratio was associated with future CAD events, independent of traditional lipid values (adjusted odds ratio, 1.85 [95% CI, 1.15 to 2.98]), including the total cholesterol-HDL cholesterol ratio, and independent of the Framingham risk score (adjusted odds ratio, 1.77 [CI, 1.31 to 2.39]). However, it did no better than lipid values at discriminating between CAD cases and controls (area under the receiver-operating characteristic curve, 0.670 for total cholesterol-HDL cholesterol ratio vs. 0.673 for apo B-apo A-I ratio [P = 0.38]) and added little to the predictive value of the Framingham risk score (area under the receiver-operating characteristic curve, 0.594 for Framingham risk score alone vs. 0.613 for Framingham risk score plus apo B-apo A-I ratio [P < 0.001]). In addition, it incorrectly classified 41.1% of cases and 50.4% of controls.
No participant was taking lipid-lowering medication, and diabetes was uncommon.
The apo B-apo A-I ratio is independently associated with, but adds little to, existing measures for CAD risk assessment and discrimination in the general population. Other characteristics of the test, such as the ability to perform it on nonfasting samples, may still make it useful in some settings.
载脂蛋白B与载脂蛋白A-I（apo B-apo A-I）比值升高是未来发生冠状动脉疾病（CAD）的一个危险因素。目前尚不清楚该比值在风险评估和预测方面是否优于传统血脂指标，以及它是否能为弗雷明汉风险评分增加预测价值。
评估apo B-apo A-I比值是否独立于传统血脂测量指标和弗雷明汉风险评分与未来CAD事件相关，并评估该比值预测未来CAD发生的能力。
前瞻性巢式病例对照研究。
英国诺福克。
欧洲癌症与营养前瞻性调查-诺福克研究中表面健康的男性和女性（45至79岁）。病例组（n = 869）为发生致命或非致命CAD的患者。对照组（n = 1511）为无CAD的患者，根据年龄、性别和入组时间进行匹配。
直接测量总胆固醇、高密度脂蛋白（HDL）胆固醇、甘油三酯、载脂蛋白和C反应蛋白水平。低密度脂蛋白（LDL）胆固醇值采用Friedewald公式计算。
apo B-apo A-I比值与未来CAD事件相关，独立于传统血脂指标（调整优势比，1.85[95%CI，1.15至2.98]），包括总胆固醇-HDL胆固醇比值，且独立于弗雷明汉风险评分（调整优势比，1.77[CI，1.31至2.39]）。然而，在区分CAD病例和对照组方面，它并不比血脂指标表现更好（受试者工作特征曲线下面积，总胆固醇-HDL胆固醇比值为0.670，apo B-apo A-I比值为0.673[P = 0.38]），且对弗雷明汉风险评分的预测价值增加不多（受试者工作特征曲线下面积，单独的弗雷明汉风险评分为0.594，弗雷明汉风险评分加apo B-apo A-I比值为0.613[P < 0.001]）。此外，它将41.1%的病例和50.4%的对照错误分类。
没有参与者正在服用降脂药物，且糖尿病不常见。
apo B-apo A-I比值与一般人群中CAD风险评估和鉴别现有指标独立相关，但增加的价值不大。该检测的其他特性，如在非空腹样本上进行检测的能力，在某些情况下可能仍有用处。
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