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GENERAL CARDIOLOGY
Should the apolipoprotein B/A1 ratio become the routine lipid measurement for cardiovascular risk stratification? From a pathophysiological point of view, the Apo B/A1 ratio is more reflective of endothelial dysfunction and atherosclerosis development than the level of low-density lipoprotein (LDL) cholesterol. However, results from several small studies (200–300 events) have been conflicting—while some showed a superiority of Apo B/A1 over conventional lipid measurements, others, including a report from the Framingham heart study, did not.
Data from the INTERHEART study were used to measure cholesterol and apolipoprotein ratios for 9345 cases of myocardial infarction and 12 120 controls. The Apo B/A1 ratio had the highest population-attributable risk (54%), compared with the LDL/high-density lipoprotein (HDL) cholesterol ratio which was 37%, and total cholesterol/HDL ratio which was 32%, significantly lower than the Apo B/A1 ratio (p<0.0001). These results were consistent across all ethnic groups, both sexes and all ages.
A trend appears to
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