Sniderman Allan D, Williams Ken, Contois John H, Monroe Howard M, McQueen Matthew J, de Graaf Jacqueline, Furberg Curt D
Mike Rosenbloom Laboratory for Cardiovascular Research, Royal Victoria Hospital, McGill University Health Centre, 687 Pine Avenue West, Montreal, Quebec, Canada.
Circ Cardiovasc Qual Outcomes. 2011 May;4(3):337-45. doi: 10.1161/CIRCOUTCOMES.110.959247. Epub 2011 Apr 12.
Whether apolipoprotein B (apoB) or non-high-density lipoprotein cholesterol (HDL-C) adds to the predictive power of low-density lipoprotein cholesterol (LDL-C) for cardiovascular risk remains controversial.
This meta-analysis is based on all the published epidemiological studies that contained estimates of the relative risks of non-HDL-C and apoB of fatal or nonfatal ischemic cardiovascular events. Twelve independent reports, including 233 455 subjects and 22 950 events, were analyzed. All published risk estimates were converted to standardized relative risk ratios (RRRs) and analyzed by quantitative meta-analysis using a random-effects model. Whether analyzed individually or in head-to-head comparisons, apoB was the most potent marker of cardiovascular risk (RRR, 1.43; 95% CI, 1.35 to 1.51), LDL-C was the least (RRR, 1.25; 95% CI, 1.18 to 1.33), and non-HDL-C was intermediate (RRR, 1.34; 95% CI, 1.24 to 1.44). The overall comparisons of the within-study differences showed that apoB RRR was 5.7%>non-HDL-C (P<0.001) and 12.0%>LDL-C (P<0.0001) and that non-HDL-C RRR was 5.0%>LDL-C (P=0.017). Only HDL-C accounted for any substantial portion of the variance of the results among the studies. We calculated the number of clinical events prevented by a high-risk treatment regimen of all those >70th percentile of the US adult population using each of the 3 markers. Over a 10-year period, a non-HDL-C strategy would prevent 300 000 more events than an LDL-C strategy, whereas an apoB strategy would prevent 500 000 more events than a non-HDL-C strategy.
These results further validate the value of apoB in clinical care.
载脂蛋白B（apoB）或非高密度脂蛋白胆固醇（HDL-C）是否能增强低密度脂蛋白胆固醇（LDL-C）对心血管疾病风险的预测能力仍存在争议。
这项荟萃分析基于所有已发表的流行病学研究，这些研究包含了对致命或非致命性缺血性心血管事件的非HDL-C和apoB相对风险的估计。分析了12篇独立报告，包括233455名受试者和22950起事件。所有已发表的风险估计值均转换为标准化相对风险比（RRR），并使用随机效应模型通过定量荟萃分析进行分析。无论单独分析还是进行直接比较，apoB都是心血管疾病风险的最有力标志物（RRR，1.43；95%CI，1.35至1.51），LDL-C是最不有力的（RRR，1.25；95%CI，1.18至1.33），非HDL-C处于中间水平（RRR，1.34；95%CI，1.24至1.44）。研究内差异的总体比较显示，apoB的RRR比非HDL-C高5.7%（P<0.001），比LDL-C高12.0%（P<0.0001），非HDL-C的RRR比LDL-C高5.0%（P=0.017）。在各项研究中，只有HDL-C在结果差异中占相当大的比例。我们使用这三种标志物中的每一种，计算了美国成年人口中处于第70百分位数以上的所有人采用高风险治疗方案可预防的临床事件数量。在10年期间，非HDL-C策略比LDL-C策略可多预防300000起事件，而apoB策略比非HDL-C策略可多预防500000起事件。
这些结果进一步验证了apoB在临床护理中的价值。
