|
High apolipoprotein B, low apolipoprotein A-I, and improvement in the prediction of fatal myocardial infarction (AMORIS study): a prospective study Goran Walldius, Ingmar Jungner, Ingar Holme, Are H Aastveit, Werner Kolar, Eugen Steiner |
AstraZeneca, Molndal; and King Gustaf V Research
Institute, Karolinska Institute, Stockholm, Sweden (Prof G Walldius
MD); CALAB Research, St Goran Hospital, Stockholm (I Jungner PhD, W
Kolar, E Steiner PhD); Center for Preventive Medicine, Ulleval Sykehus,
Oslo, Norway (Prof I Holme PhD); and Department of Mathematical
Sciences, Agricultural University of Norway, As (Prof A H Aastveit PhD)
Correspondence to: Prof Goran Walldius,
AstraZeneca, S-43183
|
Summary |
Background Apolipoprotein B (apoB) and apolipoprotein
A-I (apoA-I) are thought to be better predictors of acute myocardial infarction
than total cholesterol and LDL-cholesterol. We investigated whether apoB and
apoA-I are predictors of risk of fatal myocardial infarction. We also aimed to
establish whether apoB and apoA-I add further information about risk of fatal
myocardial infarction to that obtained with total cholesterol, triglycerides,
and LDL-cholesterol.
Methods We recruited 175 553 individuals mainly from
screening programmes. We measured concentrations of apoB, apoA-I, total
cholesterol, and triglycerides, and calculated apoB/apoA-I ratio and
concentrations of LDL-cholesterol and HDL-cholesterol. The relation between
death from acute myocardial infarction and initial values for apoB, apoA-I, and
the other lipids was examined.
Findings Mean follow-up was 66 - 8 months (SD 41 - 3) for
98 722 men and 64 - 4 months (41 - 4) for 76 831 women. 864 men and 359 women had
fatal myocardial infarction. In univariate analyses adjusted for age and in
multivariate analyses adjusted for age, total cholesterol, and triglycerides,
the values for apoB and apoB/apoA-I ratio were strongly and positively related
to increased risk of fatal myocardial infarction in men and in women. ApoA-I
was noted to be protective. In multivariate analysis, apoB was a stronger
predictor of risk than LDL-cholesterol in both sexes.
Interpretation Although LDL-cholesterol and
HDL-cholesterol are known risk factors, we suggest that apoB, apoB/apoA-I, and
apoA-I should also be regarded as highly predictive in evaluation of cardiac
risk. Although increased throughout the range of values of LDL-cholesterol,
apoB and apoA-I might be of greatest value in diagnosis and treatment in men
and women who have common lipid abnormalities, but have normal or low
concentrations of LDL-cholesterol.
Lancet 2001; 358: 2026-33