Vorster Anri, Kruger Ruan, Mels Catharina Mc, Breet Yolandi
Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
SAMRC Extramural Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
Lipids Health Dis. 2025 May 15;24(1):177. doi: 10.1186/s12944-025-02591-w.
Although conventional lipids (high density lipoprotein cholesterol (HDLC), low density lipoprotein cholesterol (LDLC), total cholesterol (TC) and triglycerides (TG)) are therapeutic targets to manage and prevent atherosclerotic cardiovascular disease (CVD), apolipoprotein (Apo) levels have sparked interest for their potential to improve CVD risk prediction. This study explored the relationships of traditional CVD risk factors with conventional lipids, as well as ApoA1, ApoB and its ratio (ApoB: ApoA1) in South African adults of African ancestry.
This study included 1697 adults (aged 29 to 94) from the Prospective Urban Rural Epidemiology (PURE) study. The CVD risk markers included body mass index (BMI), physical activity index, tobacco use, dietary fat intake, γ-glutamyl transferase (γGT) and glycated haemoglobin (HbA1C). Conventional lipids were measured in serum samples using standard methodology, while ApoA1 and ApoB were measured using a multiplex magnetic bead immunoassay.
Stratified into tertiles of conventional lipid and Apo levels, trends emerged across multiple CVD risk markers, including BMI, tobacco use, fat intake, γGT and HbA1C levels. Higher tertiles of LDLC, TC, TG, ApoB and ApoB: ApoA1, along with the lowest tertiles of HDLC and ApoA1 exhibited higher prevalence of Type II diabetes mellitus (all p ≤ 0.024) and overweight or obesity (all except for TC, p ≤ 0.024). HDLC was negatively associated and LDLC, TC, and TG were positively associated with BMI (all p < 0.001) and HbA1C (all except for TC, p ≤ 0.005). Similarly, ApoA1 associated negatively with BMI (β=-0.067 (-0.125; -0.010), p = 0.022) and HbA1C (β=-0.071 (-0.122; -0.020), p = 0.007), while ApoB associated positively with BMI (β = 0.168 (0.117; 0.218), p < 0.001). The ApoB: ApoA1 showed positive associations with BMI (β = 0.213 (0.163; 0.263), p < 0.001) and HbA1C (β = 0.123 (0.074; 0.172), p < 0.001).
In South African adults of African ancestry, ApoA1, ApoB and ApoB: ApoA1 levels are associated with various established CVD risk markers and suggests that these apolipoproteins may provide additional mechanistic insights beyond the conventional lipids to understand the aetiology of early cardiometabolic disease development.
尽管传统脂质（高密度脂蛋白胆固醇（HDLC）、低密度脂蛋白胆固醇（LDLC）、总胆固醇（TC）和甘油三酯（TG））是管理和预防动脉粥样硬化性心血管疾病（CVD）的治疗靶点，但载脂蛋白（Apo）水平因其改善CVD风险预测的潜力而引发关注。本研究探讨了非洲裔南非成年人中传统CVD危险因素与传统脂质以及载脂蛋白A1（ApoA1）、载脂蛋白B（ApoB）及其比值（ApoB:ApoA1）之间的关系。
本研究纳入了来自城乡前瞻性流行病学（PURE）研究的1697名成年人（年龄在29至94岁之间）。CVD风险标志物包括体重指数（BMI）、身体活动指数、烟草使用、膳食脂肪摄入量、γ-谷氨酰转移酶（γGT）和糖化血红蛋白（HbA1C）。使用标准方法在血清样本中测量传统脂质，而使用多重磁珠免疫测定法测量ApoA1和ApoB。
按传统脂质和Apo水平分层为三分位数后，在多个CVD风险标志物中出现了趋势，包括BMI、烟草使用、脂肪摄入、γGT和HbA1C水平。LDLC、TC、TG、ApoB和ApoB:ApoA1的较高三分位数，以及HDLC和ApoA1的最低三分位数显示出更高的2型糖尿病患病率（所有p≤0.024）和超重或肥胖患病率（除TC外所有p≤0.024）。HDLC与BMI（所有p<0.001）和HbA1C（除TC外所有p≤0.005）呈负相关，而LDLC、TC和TG与BMI和HbA1C呈正相关。同样，ApoA1与BMI（β=-0.067（-0.125；-0.010），p=0.022）和HbA1C（β=-0.071（-0.122；-0.020），p=0.007）呈负相关，而ApoB与BMI呈正相关（β=0.168（0.117；0.218），p<0.001）。ApoB:ApoA1与BMI（β=0.213（0.163；0.263），p<0.001）和HbA1C（β=0.123（0.074；0.172），p<0.001）呈正相关。
在非洲裔南非成年人中，ApoA1、ApoB和ApoB:ApoA1水平与多种已确定的CVD风险标志物相关，这表明这些载脂蛋白可能在传统脂质之外提供额外的机制性见解，以了解早期心脏代谢疾病发展的病因。
