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Elevated ApoB serum levels strongly predict early cardiovascular events
  1. Bruna Gigante1,
  2. Karin Leander1,
  3. Max Vikstrom1,
  4. Paolo Frumento2,
  5. Axel C Carlsson1,3,
  6. Matteo Bottai2,
  7. Ulf de Faire1,4
  1. 1Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, IMM, Karolinska Institutet, Stockholm, Sweden
  2. 2Division of Biostatistics, Institute of Environmental Medicine, IMM, Karolinska Institutet, Stockholm, Sweden
  3. 3Center for Family and Community Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
  4. 4Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
  1. Correspondence to Dr Bruna Gigante, Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, IMM, Nobelsväg 13, Karolinska Institutet, 17177 Stockholm, Sweden; bruna.gigante{at}


Objective ApoB exerts a pro-thrombotic and pro-atherogenic effect and promotes the progression of atherosclerotic lesions. In the present study, we investigated if elevated ApoB serum levels predicted the risk of premature cardiovascular events in a prospective Swedish cohort study of 60-year-old men and women from Stockholm.

Design A cohort consisting of every third man and woman turning 60 years of age in the large Stockholm area during the years 1997–1998 (n=4232).

Methods Incident cases of cardiovascular diseases have been recorded yearly by matching national registries. Exposure to high ApoB serum levels (≥0.9 g/l) was used to calculate the risk of cardiovascular diseases, and the time to the first cardiovascular event using Cox regression and Laplace regression, respectively.

Results Individuals exposed to high ApoB serum levels showed an increased risk of cardiovascular diseases over the 11 years of follow-up. The HR decreased over time from 2.49 at 4 years of study entry (95% CI 1.31 to 4.69) to 1.36 at 11 years (95% CI 1.01 to 1.83), after adjusting for gender, diabetes, hypertension, smoking, obesity, HDL and triglyceride serum levels. The first 5% of the individuals had a cardiovascular event nearly 2 years earlier among those with ApoB ≥0.9 g/l than among those with ApoB <0.9 g/l (p=0.001).

Conclusions Our data indicate that increased ApoB serum levels are important predictors of early cardiovascular events. It is possible that this reflects a shift over time in the effects of apoB from a more pro-thrombotic to a more pro-atherogenetic molecule.

  • ApoB
  • time to event
  • cardiovascular diseases
  • Laplace regression
  • basic science
  • inflammation
  • coronary artery disease
  • atherosclerosis
  • genetics
  • risk factors
  • gene association
  • lipids
  • lipoproteins
  • hypertension

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  • Funding The present study was funded by grants from the Swedish Research Council (2010-09533) and the Swedish Heart and Lung Foundation (2010-0313) to UdF. The funding agencies were not involved in the design of the study or in the analysis and interpretation of the data.

  • Competing interests None.

  • Patient consent All study participants gave their consent to participate in the study at the time of enrolment 1997–1998.

  • Ethics approval Ethics approval was provided by Karolinska Institutet Ethical Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.