Ann Lab Med.  2023 May;43(3):237-243. 10.3343/alm.2023.43.3.237.

Associations of LDL Cholesterol, Non-HDL Cholesterol, and Apolipoprotein B With Cardiovascular Disease Occurrence in Adults: Korean Genome and Epidemiology Study

• Yun SY
• Rim JH
• Kang H
• Lee SG
• Lim JB

• KMID: 2551707
• DOI: http://doi.org/10.3343/alm.2023.43.3.237

Abstract

Background
Despite the superiority of non-HDL cholesterol (non-HDL-C) and apolipoprotein B (ApoB) as lipid markers for atherosclerotic cardiovascular disease (ASCVD), these are only suitable as secondary markers. We compared LDL cholesterol (LDL-C), non-HDL-C, and ApoB concentrations with respect to the occurrence of cardiovascular disease in adults enrolled in the Korean Genome and Epidemiology Study (KoGES).
Methods
We used information on age; sex; medical history; family history of ASCVD; current lipid-lowering therapy; current smoking status; and creatinine, total cholesterol, HDL-C, LDL-C, triglyceride, and ApoB concentrations from 5,872 KoGES participants without ASCVD. New ASCVD development was monitored during the 8-year follow-up period. Adjusted hazard ratios (aHRs) for ASCVD of LDL-C, non-HDL-C, and ApoB concentrations were calculated based on the multivariate Cox regression analyses. The participants were also grouped as low and high according to the median values for each lipid marker, and calculated aHRs of each group combined by two lipid makers.
Results
ApoB showed the highest aHR per 1-SD for ASCVD (1.26; 95% confidence interval [CI], 1.11–1.43), followed by non-HDL-C (1.25; 95% CI, 1.11–1.41) and LDL-C (1.20; 95% CI, 1.06–1.37). The group with low LDL-C and high ApoB concentrations had a significantly higher aHR for ASCVD (1.61; 95% CI, 1.05–2.48) compared to the reference group values (low LDL-C and low ApoB concentrations). The aHR for the group with high LDL-C and low ApoB concentrations was not significant (1.30; 95% CI, 0.79–2.16).
Conclusions
ApoB, non-HDL-C, and LDL-C are independent risk factors for ASCVD. Increases in the aHR per 1-SD for ASCVD were more strongly affected by ApoB, followed by non-HDL-C and LDL-C. Participants with low LDL-C and high ApoB concentrations showed increased ASCVD risk. For individuals with ASCVD risk factors, even those presenting normal LDL-C concentrations, measuring ApoB concentrations can provide useful information for better evaluation of ASCVD risk.

Keyword

Atherosclerosis; LDL; Cholesterol; Apolipoprotein B

Figure

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  Fig. 1 Flow chart of participant selection. Abbreviation: KoGES, Korean Genome and Epidemiology Study; ASCVD, atherosclerotic cardiovascular disease.

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  Fig. 2 aHRs for atherosclerotic cardiovascular disease per 1-standard deviation increase in lipid marker concentrations. Abbreviations: aHR, adjusted hazard ratio; ApoB, apolipoprotein B; Non-HDL-C, non-HDL cholesterol; LDL-C, LDL cholesterol; CI, confidence interval.

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  Fig. 3 aHRs of participants grouped by (A) LDL-C and ApoB, (B) LDL-C and non-HDL-C, (C) non-HDL-C and ApoB. Abbreviations: aHR, adjusted hazard ratio; ApoB, apolipoprotein B; CI, confidence interval; non-HDL-C, non-HDL cholesterol; LDL-C, LDL cholesterol.

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