Cardiovascular disease is the leading cause of death worldwide, and it encompasses a wide range of diseases such as stroke and myocardial infarction, as well as atherosclerosis in many body organs.

Two proteins that carry cholesterol particles in the blood provide early and reliable risk information, according to a comprehensive study conducted by experts at Karolinska Institutet.

The researchers are now advocating for the implementation of new recommendations for recognizing cardiac risk, claiming that the findings may pave the way for early treatment, lowering morbidity and mortality rates. 

Reference values for “bad” LDL cholesterol are commonly used to identify increased cardiac risk. Other forms of fat particles are evaluated with apolipoproteins, which carry cholesterol in the blood, in some medical disorders. For persons with type 2 diabetes, a high BMI, and very high blood lipid levels, international guidelines for cardiovascular disease advocate utilizing the apolipoprotein apoB, which transports the “bad” cholesterol, as an alternative risk measure.

Recent study has shown, however, that the apolipoprotein apoA-1, which transports the “good” protective and anti-inflammatory HDL cholesterol, is equally important to consider. The apoB/apoA-1 ratio is used to calculate a risk quotient that reflects the balance between “bad” fat particles that speed up atherosclerosis and “good” protective apoA-1 particles that slow it down.

The researchers looked at the relationship between cardiovascular disease and apoB/apoA-1 levels in over 137,000 Swedish men and women aged 25 to 84 in this study. The participants were monitored for 30 years, during which time 22,000 of them had a heart attack or stroke. The techniques of analysis are easy, inexpensive, and safe, and they do not necessitate fasting prior to the test, as is the case with LDL and non-HDL tests. The researchers used a huge database (AMORIS) to correlate laboratory analyses to many clinical diagnosis records.

“The results show that the higher the apoB/apoA-1 value, the greater the risk of myocardial infarction, stroke and need for coronary surgery,” said Göran Walldius, senior author and professor emeritus at the Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet.

“The study also showed that the risk was amplified in the presence of low protective levels of apoA-1.”

When compared to those with the lowest apoB/apoA-1 values, those with the highest apoB/apoA-1 values had a 70% higher risk of serious cardiovascular disease and a nearly tripled risk of non-fatal myocardial infarction. Individuals with the highest risk quotient were also more likely to develop severe cardiovascular disease several years before those with the lowest apoB/apoA-1 levels.

The link was seen in both men and women, and increased levels might be discovered as early as 20 years before the beginning of heart disease.

“Early preventive treatment and information about cardiovascular risk is, of course, important in enabling individuals to manage their risk situation,” said Walldius.

“Early treatment can also reduce the cost burden on the public health services.”

According to the researchers, the data show that the apoB/apoA-1 ratio is a better marker for identifying more people at risk of future cardiovascular disease than the apoB approach alone.

“It should be possible to introduce cut-values for apoB, apoA-1 and the apoB/apoA-1 ratio into new guidelines as a complement to current guidance on the detection and treatment of dyslipidaemia,” said Walldius.

Source: 10.1371/journal.pmed.1003853

Image Credit: Getty

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