Comparison of Apolipoprotein-B/Apolipoprotein-AI in Subjects With Versus Without the Metabolic Syndrome

doi:10.1016/j.amjcard.2006.06.029

The American Journal of Cardiology

Volume 98, Issue 10, 15 November 2006, Pages 1369-1373

https://doi.org/10.1016/j.amjcard.2006.06.029 Get rights and content

Recent studies have suggested that the apolipoprotein-B (apo-B)/apolipoprotein-AI (apo-AI) ratio predicts cardiovascular risk better than any of the cholesterol indexes. The aim of the present study was to assess if the apo-B/apo-AI ratio is related to the metabolic syndrome and its components. Data were analyzed from 2,964 subjects (mean age 48 years; 1,516 men, 1,448 women) from the National Health and Nutrition Examination Survey III with apolipoprotein data who were evaluated for the metabolic syndrome and its components. The metabolic syndrome was defined according to the criteria of the National Cholesterol Education Program Adult Treatment Panel III and the International Diabetes Federation. The mean values of the apo-B/apo-AI ratio in subjects with and without the metabolic syndrome were compared. Overall, the median distribution of the apo-B/apo-AI ratio was significantly greater (p <0.0001) in subjects with the Adult Treatment Panel III metabolic syndrome (0.90) than without (0.69). The apo-B/apo-AI ratio was associated significantly with each of the metabolic syndrome components, in descending order of magnitude: low high-density lipoprotein cholesterol (odds ratio [OR] 5.7), high triglycerides (OR 4.7), high waist circumference (OR 2.6), high fasting glucose (OR 1.9), and high blood pressure (OR 1.5). The apo-B/apo-AI ratio was also different between subjects with and without the metabolic syndrome. Mean values of apo-B/apo-AI increased significantly as the numbers of metabolic syndrome components increased in men (p <0.0001) and women (p <0.0001). After excluding high-density lipoprotein cholesterol and triglycerides as criteria for the metabolic syndrome, the association between means persisted (analysis of variance p <0.0001) in men and women. Apo-B/apo-AI was significantly associated with the presence of the metabolic syndrome (OR 5.1, p <0.0001). In conclusion, the apo-B/apo-AI ratio is strongly associated with the presence of individual metabolic syndrome components, with the metabolic syndrome itself, and with insulin resistance. An elevated apo-B/apo-AI ratio may constitute an important feature of the metabolic syndrome and may provide an additional mechanism to explain the increased cardiovascular risk in subjects with this syndrome.

Section snippets

Methods and Results

The NHANES is a representative sample of the noninstitutionalized civilian population of the United States from 1988 to 1994. It consists of a periodic survey conducted by the National Center for Health Statistics designed to provide an estimate of the health of the nation. Detailed methods used in NHANES III are available for public access on the World Wide Web at http://www.cdc.gov/nchs/nhanes.htm.

NHANES information was obtained from in-home interviews followed by medical evaluations and

Discussion

In this study of a representative sample of the noninstitutionalized civilian population of the United States, the apo-B/apo-AI ratio was associated with the metabolic syndrome and its components in men and women. The mean values of the apo-B/apo-AI ratio were associated with the presence and number of nonlipidic components of the metabolic syndrome, even after excluding patients with low HDL or high triglycerides. This important finding provides a novel perspective in the understanding of the

Acknowledgment

The data reported here were analyzed using NHANES files available for public use. All analysis, interpretation, and conclusions reached in this study were the work of the investigators, not of the National Center for Health Statistics.

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Associations between maternal mid-pregnancy apolipoprotein A-1, apolipoprotein B, apolipoprotein B/apolipoprotein A-1 ratio and preterm birth
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Subgroup analyses suggested that the effect of elevated ApoB or ApoB/ApoA-1 ratio was more relevant among women with pre-pregnancy BMI ≤ 24 kg/m2, or age at delivery ≥ 35 years. Elevated ApoB level or ApoB/ApoA-1 ratio represents a more atherogenic lipid profile and was known to be related to several chronic diseases including metabolic syndrome [17], insulin resistance [18], and cardiovascular disease [16] among the non-pregnant population. Previous studies have investigated the relationship between maternal apolipoprotein profile and pregnancy complications.
Elevated lipid levels during pregnancy have been shown to be related to the risk of preterm birth. Despite the importance of apolipoprotein (Apo) in lipid metabolism and transportation, evidence regarding apolipoprotein levels during pregnancy and preterm birth is still limited. Therefore, we aim to investigate the associations between maternal ApoA-1, ApoB, ApoB/ApoA-1 ratio and preterm birth.
Data were extracted from the information system of Guangdong Women and Children Hospital. Lipoprotein levels were tested using Beckman Coulter AU5800 in mid-pregnancy at a median gestational age of 18 w. Maternal serum ApoB, ApoA-1 and ApoB/ApoA-1 ratio were categorized into tertiles. Logistic regression models were performed to evaluate the odds ratios and 95% confidence intervals for preterm birth.
A total of 5,986 maternal-newborn pairs were included in this study. The rate of preterm birth was 5.7% (n = 344). The multivariate-adjusted ORs (95% CI) of preterm birth were 1.51 (1.06, 2.10) for individuals with high ApoB (>90th), 0.63 (0.38, 0.99) for those with low ApoB (<10th), and 1.64 (1.18, 2.24) for those with high ApoB/ApoA-1 (>90th). Subgroup analyses showed that the association of ApoB and preterm birth was only significant among women with pre-pregnancy BMI 18.5-24 kg/m² (OR = 1.36, 95% CI: 1.12–1.65), age at delivery ≥ 35 years (OR = 1.43, 95% CI: 1.12–1.83).
Elevated maternal ApoB level and ApoB/ApoA-1 ratio during mid-pregnancy were related to increased risk of preterm birth. Monitoring maternal serum apolipoprotein levels may help to identify the high-risk population of preterm birth.
Biomarkers in metabolic syndrome
2022, Advances in Clinical Chemistry
Citation Excerpt :
Many studies have confirmed the ApoB/ApoA1 ratio as a marker for MetS [322–327]. A 2006 study on 2964 subjects (1516 men and1,448 women; mean 48 y) reported that the ApoB/ApoA1 ratio was significantly associated with MetS (N) (OR = 5.1, P < 0.0001) [326]. In the ATTICA study (1514 men, 18–87 y and 1528 women,18–89 y), an ApoB/ApoA1 ratio > 0.74 had 3.29 times higher OR of having MetS (N) [325].
Metabolic syndrome (MetS) is a global health challenge characterized as a group of risk factors for developing atherosclerotic cardiovascular disease. Although visceral adipose tissue, adipocyte dysfunction, chronic low-grade inflammation, and insulin resistance are fundamental to MetS, the exact biochemical mechanisms underlying this disease state remain unclear. Numerous biomarkers, however, have been proposed to improve our understanding of its complex pathophysiology and facilitate diagnosis. This review examines these biomarkers and clarifies their potential roles in the pathogenesis, diagnosis, prediction, progression, and severity of MetS and MetS-related disorders.
Adipose Tissue in Metabolic Syndrome: Onset and Progression of Atherosclerosis
2015, Archives of Medical Research
Metabolic syndrome (MetS) should be considered a clinical entity when its different symptoms share a common etiology: obesity/insulin resistance as a result of a multi-organ dysfunction. The main interest in treating MetS as a clinical entity is that the addition of its components drastically increases the risk of atherosclerosis. In MetS, the adipose tissue plays a central role along with an unbalanced gut microbiome, which has become relevant in recent years. Once visceral adipose tissue (VAT) increases, dyslipidemia and endothelial dysfunction follow as additive risk factors. However, when the nonalcoholic fatty liver is present, risk of a cardiovascular event is highly augmented. Epicardial adipose tissue (EAT) seems to increase simultaneously with the VAT. In this context, the former may play a more important role in the development of the atherosclerotic plaque than the latter. Hence, EAT may act as a paracrine tissue vis-à-vis the coronary arteries favoring the local inflammation and the atheroma calcification.
Association between Apolipoprotein B/Apolipoprotein A-1 and arterial stiffness in metabolic syndrome
2014, Clinica Chimica Acta
Citation Excerpt :
Fasting serum insulin was determined by means of chemiluminescence (RIA kit, Daiichi, Japan), and insulin resistance was estimated using the homeostasis model assessment of insulin resistance (HOMA-IR) index, calculated from the following formula: HOMA-IR = fasting insulin (μU/ml) × fasting plasma glucose (mmol/l) / 22.5. Apo A-1 and Apo B were measured by an immunoturbidimetric method (Cobas Integra 800 Analyzer; Roche Diagnostics) using standard procedures [19]. Arterial stiffness was measured using a PP-1000 pulse wave analyzer (Hanbyul Meditech Co.), as previously described [20].
Apolipoprotein B/Apolipoprotein A-1 ratio (Apo B/Apo A-1) is known to be associated with atherosclerotic vascular disease. However, few studies have investigated the relationship between Apo B/Apo A-1 ratio and arterial stiffness, thus we investigated the relationships between Apo B/Apo A-1 and arterial stiffness in patients with metabolic syndrome (MetS).
1252 subjects with MetS according to the Adult Treatment Panel III were enrolled in our study. Anthropometric profiles and serum concentrations of Apo B, Apo A-1, fasting plasma glucose (FPG), total cholesterol (TC), triglycerides (TG), and high density lipoprotein cholesterol (HDL-C) were measured. Pulse wave velocity (PWV) was evaluated to assess arterial stiffness.
The subjects were stratified into four groups according to their Apo B/Apo A-1 ratios. PWV gradually increased according to Apo B/Apo A-1 quartiles. After adjusting for age, arterial stiffness was significantly correlated with systolic blood pressure, diastolic blood pressure, FPG, homeostasis model assessment (HOMA-IR), Apo B and Apo B/Apo A-1. In multiple logistic regression analysis after adjusting for risk factors, Apo B/Apo A-1 ratio was a significant contributor to increased PWV.
These results suggest that Apo B/Apo A-1 is independently associated with increased arterial stiffness in patients with MetS.
Among young Sri Lankan patients with diabetes, how do lipid profiles differ between those with and without metabolic syndrome?
2019, Diabetes and Metabolic Syndrome: Clinical Research and Reviews
Metabolic syndrome (MetS) is a risk factor for cardiovascular disease (CVD). Apolipoproteins are emerging as powerful predictors of CVD. We aimed to study associations of metabolic syndrome and apoB, apoAI, apoB/AI ratio in young Sri Lankans with type 2 diabetes.
Blood samples were available from 690 patients with type 2 diabetes in Sri Lanka Young Diabetes Study, and were analysed for apoB, apoAI, total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), triglycerides (TG) and glycated haemoglobin (HbA_1c). Their associations with MetS as perNCEP/ATPIII criteria were studied.
MetS was present in 60.9% of subjects. Of those with MetS, 76.0% were women. Those with MetS had higher apoB (1.27 V s 1.19 mmol/L; p = 0.001), apoB/AI (0.80 V s 0.75; p = 0.001), non-HDL cholesterol (NHDLC) (4.15 V s 3.98 mmol/L; p = 0.002),and triglycerides (1.51 V s 1.31 mmol/L; p < 0.001) and lower apoAI (1.58 V s 1.60 mmol/L; p = 0.03) and HDLC (1.02 V s 1.16 mmol/L, p < 0.001). ApoB and apoB/AIlevels increased significantly as the number of MetS components increased. ApoB and apoB:AI ratio were independently associated with MetS and components.
MetS showed a high prevalence among young Sri Lankans with diabetes. Elevated apoB is commonly clustered with other risk indicators in MetS.
Association of apolipoproteins and lipoprotein(a) with metabolic syndrome: a systematic review and meta-analysis
2023, Lipids in Health and Disease

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: Dr. Somers was supported in part by Grant NIH R01 HL73211 from the National Institutes of Health, Bethesda, Maryland. Dr. Lopez-Jimenez was supported in part by a Scientist Development Award from the American Heart Association, Dallas, Texas.

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Preventive cardiologyComparison of Apolipoprotein-B/Apolipoprotein-AI in Subjects With Versus Without the Metabolic Syndrome

Section snippets

Methods and Results

Discussion

Acknowledgment

Non-HDL cholesterol and apolipoprotein B predict cardiovascular disease events among men with type 2 diabetes

Diabetes Care

Comparison of the associations of apolipoprotein B and low-density lipoprotein cholesterol with other cardiovascular risk factors in the Insulin Resistance Atherosclerosis Study (IRAS)

Circulation

Non-high-density lipoprotein cholesterol and apolipoprotein B in the prediction of coronary heart disease in men

Circulation

Prognostic value of apolipoprotein B and A-I in the prediction of myocardial infarction in middle-aged men and women: results from the MONICA/KORA Augsburg cohort study

Eur Heart J

The apoB/apoA-I ratio is better than the cholesterol ratios to estimate the balance between plasma proatherogenic and antiatherogenic lipoproteins and to predict coronary risk

Clin Chem Lab Med

Comparison of the associations of apolipoprotein B and non-high-density lipoprotein cholesterol with other cardiovascular risk factors in patients with the metabolic syndrome in the Insulin Resistance Atherosclerosis Study

Circulation

Preventive cardiology
Comparison of Apolipoprotein-B/Apolipoprotein-AI in Subjects With Versus Without the Metabolic Syndrome