How Do Apolipoproteins ApoB and ApoA-I Perform in Patients with Acute Coronary Syndromes

How Do Apolipoproteins ApoB and ApoA-I Perform in Patients with Acute Coronary Syndromes Acute coronary syndromes are the leading cause of hospitalization and death. Results from recent studies suggest that apolipoprotein measurement and apoB:apoA-I are superior to traditional lipids in the estimation of coronary risk. We compared apolipoprotein concentrations and apoB:apoA-I with traditional lipid measures and atherogenic indices in patients diagnosed with acute coronary syndromes (ACS) within 6 hrs from the onset of chest pain. A study group consisted of 227 patients diagnosed with ACS (STEMI=60, NSTEMI=66 and UA=105). Clinically healthy volunteers (n=85) served as controls. Measurements of cardiac TnI, lipid profile, hsCRP, apolipoprotein A-I and apoB100 were performed and apoB:apoA-I, TC-HDL-C, LDL-C:HDL-C ratios were calculated. Patients had increased LDL-C (>3.0 mmol/L) and non-HDL-C (>3.4 mmol/L). Triglycerides were below the cut-off value, but patients had significantly higher TG concentrations and lower HDL-C compared to controls (p<0.001). Apo B and apoA-I concentration in patients remained within the accepted range. Atherogenic indices TC:HDL-C, LDL-C:HDL-C and apoB:apoA-I were significantly increased in patients. ApoB:apoA-I ratio in ACS males was within low risk whereas in females corresponded to medium risk. ApoB:apoA-I and LDL-C:HDL-C ratios were of good diagnostic utility for discrimination between patients and controls (AUC 0.71 and 0.79; respectively). ApoB:apoA-I and LDL-C:HDL-C were of very good diagnostic utility for discrimination between STEMI patients and controls (AUC 0.80 and 0.84). We could not show the superiority of apoB:apoA-I over LDL-C:HDL-C as the discrimination power of both was almost identical. Determination of apolipoproteins should not be recommended for routine clinical use, however, incorporating apoB and apoB:apoA-I into risk assessment could provide additional important information on cardiovascular risk. Koliko Su Efikasni Apolipoproteini ApoB I ApoA-I Kod Pacijenata Sa Akutnim Koronarnim Sindromima Akutni koronarni sindrom predstavlja vodeći uzrok hospitalizacija i smrti. Rezultati skorašnjih studija pokazuju da se u proceni koronarnog rizika bolje pokazalo merenje apolipoproteina i apoB:apoA-I nego tradicionalnih lipida. Uporedili smo koncentracije apolipoproteina i apoB:apoA-I sa tradicionalnim lipidskim merama i aterogenim indeksima kod pacijenata sa dijagnozom akutnog koronarnog sindroma (ACS) u roku od 6 sati od nastanka bola u grudima. Proučavanu grupu činilo je 227 pacijenata sa dijagnozom ACS (STEMI=60, NSTEMI=66 i nestabilna angina pektoris=105). Klinički zdravi dobrovoljci (n=85) služili su kao kontrola. Izmereni su srčani TnI, lipidski profil, hsCRP, apolipoprotein A-I i apoB100 i izračunati odnosi apoB:apoA-I, TC-HDL-C, LDL-C:HDL-C. Pacijenti su imali povišen LDL-C (>3,0 mmol/L) i ne-HDL-C (>3,4 mmol/L). Trigliceridi su bili ispod cut-off vrednosti, ali pacijenti su imali značajno više koncentracije TG i niži HDL-C u poređenju sa kontrolama (p<0,001). Koncentracija apo B i apoA-I kod pacijenata ostala je u okviru prihvaćenog opsega. Aterogeni indeksi TC:HDL-C, LDL-C:HDL-C i apoB:apoA-I bili su značajno viši kod pacijenata. Odnos apoB:apoA-I kod muškaraca sa ACS ukazivao je na nizak rizik, dok je kod žena odgovarao srednjem riziku. Odnosi apoB:apoA-I i LDL-C:HDL-C bili su dijagnostički korisni za razlikovanje pacijenata od kontrola (AUC 0,71 i 0,79). ApoB:apoA-I i LDL-C:HDL-C bili su veoma dijagnostički korisni za diskriminaciju između pacijenata sa STEMI i kontrola (AUC 0,80 i 0,84). Nismo uspeli da pokažemo superiornost apoB-apoA-I u odnosu na LDL-C:HDL-C pošto je njihova diskriminatorna moć gotovo identična. Određivanje apolipoproteina ne bi trebalo preporučivati za rutinsku kliničku upotrebu, međutim, uključivanje apoB i apoB:apoA-I u procenu rizika moglo bi obezbediti dodatne važne informacije o kardiovaskularnom riziku.