New way of identifying early risk of cardiovascular disease

Date:
December 1, 2021
Source:
Karolinska Institutet
Summary:
The risk of developing cardiovascular disease is strongly associated
with 'bad' LDL cholesterol. A large study now shows that two
proteins that transport cholesterol particles in the blood provide
early and reliable risk information. The researchers now advocate
introducing new guidelines for detecting cardiac risk and say the
results may pave the way for early treatment, which could help
lower morbidity and fatality rates.



FULL STORY ==========================================================================
The risk of developing cardiovascular disease is strongly associated with
the "bad" LDL cholesterol. A large study by scientists at Karolinska
Institutet now shows that two proteins that transport cholesterol
particles in the blood provide early and reliable risk information. The researchers now advocate introducing new guidelines for detecting
cardiac risk and say the results may pave the way for early treatment,
which could help lower morbidity and fatality rates.


========================================================================== Cardiovascular disease is the most common cause of death globally
and includes a wide range of conditions, such as stroke and myocardial infarction with atherosclerosis in different organs of the body. In many
cases the disease can be prevented and arrested with lifestyle changes
and lipid-lowering treatments using statins and other methods.

The data generally used to assess elevated cardiac risk are reference
values for the "bad" LDL cholesterol. In some medical conditions, other
types of fat particles are also measured along with apolipoproteins,
which transport cholesterol in the blood. International guidelines
for cardiovascular disease recommend using the apolipoprotein apoB,
which transports the "bad" cholesterol, as an alternative risk marker
for people with type 2 diabetes, overweight (high BMI) and very high
levels of blood lipids.

Recent research has, however, indicated the importance of also factoring
in the apolipoprotein apoA-1, which transports the "good" protective
and anti- inflammatory HDL cholesterol. Calculating the apoB/apoA-1
ratio gives a risk quotient reflecting the balance between the "bad"
fat particles that expedite atherosclerosis and the "good" protective
apoA-1 particles that arrest the process.

In this present study, the researchers have analysed the link between cardiovascular disease and apoB/apoA-1 values in more than 137,000
Swedish men and women between the ages of 25 and 84. The individuals
were followed for 30 years, during which time 22,000 suffered some form
of cardiovascular event. The analysis methods are simple, inexpensive
and safe, and do not require pre-test fasting, as is the case with LDL
and non-HDL tests. Basing their study on a large database (AMORIS),
the researchers linked the laboratory analyses to several clinical
diagnosis registers.

"The results show that the higher the apoB/apoA-1 value, the greater the
risk of myocardial infarction, stroke and need for coronary surgery," says Go"ran 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." Individuals with the highest apoB/apoA-1
values had a 70 percent greater risk of severe cardiovascular disease
and almost triple the risk of non-fatal myocardial infarction compared
with those with the lowest apoB/apoA-1 values.

Individuals with the highest risk quotient were also more affected by
severe cardiovascular diseases many years earlier than individuals with
the lowest apoB/apoA-1 values.

The relationship was observed in both men and women and the elevated
levels could be detected as early as 20 years before the onset of cardiovascular disease.

"Early preventive treatment and information about cardiovascular
risk is, of course, important in enabling individuals to manage their
risk situation," Walldius says. "Early treatment can also reduce the
cost burden on the public health services." All in all, the results
indicate that the apoB/apoA-1 ratio is a better marker for identifying
more individuals at risk of future cardiovascular disease than the apoB
method alone, according to the researchers.

"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," Walldius says.

The study was financed by the Gunnar and Ingmar Jungner Foundation for Laboratory Medicine.

========================================================================== Story Source: Materials provided by Karolinska_Institutet. Note: Content
may be edited for style and length.


========================================================================== Journal Reference:
1. Go"ran Walldius, Ulf de Faire, Lars Alfredsson, Karin Leander, Peter
Westerholm, Haakan Malmstro"m, Torbjo"rn Ivert, Niklas
Hammar. Long-term risk of a major cardiovascular event by apoB,
apoA-1, and the apoB/apoA- 1 ratio--Experience from the Swedish
AMORIS cohort: A cohort study. PLOS Medicine, 2021; 18 (12):
e1003853 DOI: 10.1371/journal.pmed.1003853 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/12/211201145319.htm

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