Department of Laboratory Medicine & Pathology, University of Minnesota, Minneapolis, MN, USA.
Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
J Clin Lipidol. 2017 Sep-Oct;11(5):1181-1191.e1. doi: 10.1016/j.jacl.2017.07.001. Epub 2017 Jul 12.
High blood cholesterol contributes to atherosclerosis, yet reliance on the lipid panel alone may mischaracterize individuals with elevated lipoprotein particle numbers.
The aim of the article was to determine whether elevated lipoprotein or apolipoprotein measures are associated with carotid atherosclerosis and plaque progression independent of cardiovascular (CV) risk factors including standard lipids in a subcohort of 2228 Multi-Ethnic Study of Atherosclerosis participants.
Ultrasonography assessed carotid artery plaque and common carotid intima-media thickness (cIMT) at baseline and after a median period of 9.4 years. Nuclear magnetic resonance spectroscopy estimated lipoprotein particle concentrations. Apolipoprotein B (ApoB) and apolipoprotein A-I were measured using an automated immunoassay. Regression analysis determined associations of apolipoprotein and lipoprotein measurements with cIMT and relative risk regression determined associations with carotid plaque progression.
After adjustment for typical CV risk factors, individuals in top quartiles of ApoB, ApoB/apolipoprotein A-I, low-density lipoprotein particles (LDL-P), small LDL-P, and total LDL-P/high-density lipoprotein (HDL) particles showed similar risks of carotid plaque and cIMT progression as LDL-C, non-HDL cholesterol (HDL-C), total cholesterol (TC), and TC/HDL-C. A significant association with plaque progression remained in the top ApoB quartile after further adjustment for LDL-C (P = .02) or TC + HDL-C (P = .04), but was nonsignificant when adjusted for all lipid covariates (P = .086). Those in the top quartile of small LDL-P concentrations showed greater cIMT progression than those in the referent after adjustment for LDL-C, but this was nonsignificant after adjustment for TC + HDL-C.
When coupled with evidence that apolipoprotein testing identifies lipid-lipoprotein discordance, these findings suggest that ApoB and small LDL-P provide atherosclerosis risk information that is not revealed by typical CV risk factors.
高血胆固醇会导致动脉粥样硬化，但仅依赖血脂谱可能会错误描述脂蛋白颗粒数升高的个体。
本文旨在确定脂蛋白或载脂蛋白测量值是否与颈动脉粥样硬化和斑块进展相关，这些进展独立于心血管（CV）危险因素，包括标准脂质，在 2228 名多民族动脉粥样硬化研究参与者的亚队列中。
超声评估颈动脉斑块和颈总动脉内膜中层厚度（cIMT）在基线和中位数 9.4 年后。核磁共振光谱估计脂蛋白颗粒浓度。使用自动化免疫测定法测量载脂蛋白 B（ApoB）和载脂蛋白 A-I。回归分析确定载脂蛋白和脂蛋白测量值与 cIMT 的关联，相对风险回归确定与颈动脉斑块进展的关联。
在调整典型 CV 危险因素后，ApoB、ApoB/载脂蛋白 A-I、低密度脂蛋白颗粒（LDL-P）、小 LDL-P 和总 LDL-P/高密度脂蛋白（HDL）颗粒处于前四分位数的个体，其颈动脉斑块和 cIMT 进展的风险与 LDL-C、非高密度脂蛋白胆固醇（HDL-C）、总胆固醇（TC）和 TC/HDL-C 相似。在进一步调整 LDL-C（P=0.02）或 TC+HDL-C（P=0.04）后，在前 ApoB 四分位数中与斑块进展仍存在显著关联，但在调整所有脂质协变量后不显著（P=0.086）。在调整 LDL-C 后，小 LDL-P 浓度处于前四分位数的个体比参照组的 cIMT 进展更大，但在调整 TC+HDL-C 后，这种关联不显著。
结合载脂蛋白检测可识别脂质-脂蛋白不一致性的证据，这些发现表明 ApoB 和小 LDL-P 提供了典型 CV 危险因素未揭示的动脉粥样硬化风险信息。
