载脂蛋白 B 与低密度脂蛋白胆固醇和非高密度脂蛋白胆固醇的不匹配与动脉粥样硬化多民族研究（MESA）中的冠状动脉钙化有关。
Apolipoprotein B discordance with low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol in relation to coronary artery calcification in the Multi-Ethnic Study of Atherosclerosis (MESA).
机构信息
Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA; Department of Pathology, Texas Children's Hospital, Houston, TX, USA.
Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA.
出版信息
J Clin Lipidol. 2020 Jan-Feb;14(1):109-121.e5. doi: 10.1016/j.jacl.2019.11.005. Epub 2019 Nov 29.
BACKGROUND
Discordant levels of apolipoprotein B (apo B) relative to low-density lipoprotein cholesterol (LDL-C) or non-high-density lipoprotein cholesterol (non-HDL-C) may be associated with subclinical atherosclerotic cardiovascular disease (ASCVD).
OBJECTIVE
The present study investigated whether discordance between apo B and LDL-C or non-HDL-C levels was associated with subclinical ASCVD measured by coronary artery calcium (CAC).
METHODS
This study was conducted in a subpopulation of the Multi-Ethnic Study of Atherosclerosis (MESA) cohort, aged 45 to 84 years, free of ASCVD, and not taking lipid-lowering medications at the baseline (2000-2002) (prevalence analytic N = 4623; incidence analytic N = 2216; progression analytic N = 3947). Apo B discordance relative to LDL-C and non-HDL-C was defined using residuals and percentile rankings (>5/10/15 percentile). Associations with prevalent and incident CAC (CAC > 0 vs CAC = 0) were assessed using prevalence ratio/relative risk regression and CAC progression (absolute increase/year) using multinomial logistic regression.
RESULTS
Higher apo B levels were associated with CAC prevalence, incidence, and progression. Apo B discordance relative to LDL-C or non-HDL-C was inconsistently associated with CAC prevalence and progression. Discordantly high apo B relative to LDL-C and non-HDL-C was associated with CAC progression. Associations for apo B discordance with non-HDL-C remained after further adjustment for metabolic syndrome components.
CONCLUSION
Apo B was associated with CAC among adults aged ≥45 years not taking statins, but provided only modest additional predictive value of apo B for CAC prevalence, incidence, or progression beyond LDL-C or non-HDL-C. Apo B discordance may still be important for ASCVD risk assessment and further research is needed to confirm findings.
背景
载脂蛋白 B（apoB）与低密度脂蛋白胆固醇（LDL-C）或非高密度脂蛋白胆固醇（non-HDL-C）水平不一致可能与亚临床动脉粥样硬化性心血管疾病（ASCVD）有关。
目的
本研究旨在探讨apoB 与 LDL-C 或 non-HDL-C 水平不一致与冠状动脉钙（CAC）测量的亚临床 ASCVD 之间的关系。
方法
该研究在动脉粥样硬化多民族研究（MESA）队列的亚人群中进行，年龄在 45 至 84 岁之间，无 ASCVD 病史，且基线时（2000-2002 年）未服用降脂药物（流行率分析 N=4623；发生率分析 N=2216；进展分析 N=3947）。使用残差和百分位排名（>5/10/15 百分位）定义 apoB 与 LDL-C 和 non-HDL-C 不一致的情况。使用患病率比/相对风险回归评估与 CAC 流行率和发生率（CAC>0 与 CAC=0）的相关性，使用多项逻辑回归评估 CAC 进展（每年绝对增加）。
结果
apoB 水平较高与 CAC 流行率、发生率和进展有关。apoB 与 LDL-C 或 non-HDL-C 不一致与 CAC 流行率和进展不一致相关。与 LDL-C 和 non-HDL-C 相比，apoB 水平不一致与 CAC 进展相关。在进一步调整代谢综合征成分后，apoB 与 non-HDL-C 不一致的相关性仍存在。
结论
apoB 与未服用他汀类药物的年龄≥45 岁成年人的 CAC 相关，但与 LDL-C 或 non-HDL-C 相比，apoB 对 CAC 流行率、发生率或进展的预测价值仅略有增加。apoB 不一致对于 ASCVD 风险评估仍很重要，需要进一步研究证实这些发现。
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