Article Impact Level: HIGH Data Quality: STRONG Summary of European Heart Journal, ehaf207. https://doi.org/10.1093/eurheartj/ehaf207 Dr. Jakub Morze et al.
Points
- This study found that higher concentrations of apolipoprotein B-containing particles were strongly associated with an increased risk of coronary artery disease among 207,368 UK Biobank participants.
- A one standard deviation increase in apoB-P concentration raised the risk of coronary artery disease by 33 percent, confirming its value as a key predictor of atherosclerotic risk.
- While VLDL particles had a higher per-particle risk, LDL particles were far more abundant, making total apoB-P count the dominant factor in determining coronary risk.
- Once the multivariable model accounted for total apoB-P concentration, particle size and subclass offered no additional predictive value.
- Elevated lipoprotein(a) levels remained independently associated with coronary artery disease and improved risk prediction beyond apoB-P concentration alone.
Summary
Apolipoprotein B (apoB) concentration is a well-established marker of atherosclerotic risk, reflecting the number of atherogenic lipoproteins. This study aimed to assess whether the type or size of apoB-containing particles (apoB-P) provides additional predictive value for coronary artery disease (CAD). The study used data from 207,368 UK Biobank participants with detailed lipoprotein profiling, excluding those with prior atherosclerotic disease, diabetes, or active lipid-lowering therapy. Multivariable-adjusted Cox regression models were used to analyze associations between apoB-P and various lipid parameters (VLDL, LDL, Lp(a), and particle size) with incident CAD.
The results showed that a one standard deviation increase in apoB-P was associated with a 33% higher risk of CAD (hazard ratio [HR]: 1.33, 95% CI: 1.30–1.36). Although VLDL particles were linked to a higher per-particle risk (HR per 100 nmol/L: 1.22, 95% CI: 1.11–1.34), this was counterbalanced by the higher relative abundance of LDL particles (91% vs 9%). After adjusting for particle abundance, the HR for LDL and VLDL were 1.09 (95% CI: 1.05–1.14) and 1.24 (95% CI: 1.19–1.30), respectively. The study found no association between particle size or subclasses and CAD after adjusting for apoB-P. The association of lipoprotein(a) (Lp(a)) with CAD remained robust after adjusting for apoB-P, with an HR of 1.18 (95% CI: 1.16–1.20), and Lp(a) added independent prognostic value for CAD (area under the curve: 0.769 vs 0.774, P < 0.001).
In conclusion, the total count of apoB-P is the most reliable indicator of lipid-related atherosclerotic risk, with little additional benefit from considering particle type or size. Elevated Lp(a) levels provide additional risk, highlighting the importance of assessing both apoB-P and Lp(a) concentrations for accurate dyslipidemia-related atherosclerotic risk prediction.
Link to the article: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaf207/8118996
References Morze, J., Melloni, G. E. M., Wittenbecher, C., Ala-Korpela, M., Rynkiewicz, A., Guasch-Ferré, M., Ruff, C. T., Hu, F. B., Sabatine, M. S., & Marston, N. A. (2025). ApoB-containing lipoproteins: Count, type, size, and risk of coronary artery disease. European Heart Journal, ehaf207. https://doi.org/10.1093/eurheartj/ehaf207
