ApoB/LDL-C discordance as a predictor of atherosclerotic cardiovascular disease in genetically confirmed heterozygous familial hypercholesterolemia: A hypothesis-generating cohort study.
• ApoB/LDL-C discordance associates with ASCVD risk in HeFH. • High ApoB/LDL-C ratios correlate with increased event rates. • rdance captures residual risk missed by LDL-C alone. • Findings support ApoB use for HeFH risk stratification. In heterozygous familial hypercholesterolemia (HeFH), low-densi...
| Publicado en: | Journal of Clinical Lipidology Vol. 20; no. 3; pp. 490 - 504 |
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| Autores principales: | , |
| Formato: | research Journal Article |
| Publicado: |
Elsevier B.V.
Mar2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=192377919&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 192377919 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 19332874 54Y0 jtl: Journal of Clinical Lipidology issn: 19332874 maglogo: N pubinfo: dt: Mar2026 vid: 20 iid: 3 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 192377919 192377919 192377919 10.1016/j.jacl.2025.11.008 192377919 ppf: 490 ppct: 14 formats: tig: atl: ApoB/LDL-C discordance as a predictor of atherosclerotic cardiovascular disease in genetically confirmed heterozygous familial hypercholesterolemia: A hypothesis-generating cohort study. aug: au: Genedy, Nader Zouwail, Soha affil: Department of Metabolic Medicine, University Hospital of Wales, Cardiff, Wales, UK sug: subj: Lipoproteins, LDL Blood Apolipoproteins Blood Coronary Arteriosclerosis Risk Factors Hypercholesterolemia, Familial Complications Hypercholesterolemia, Familial Familial and Genetic Risk Assessment Cardiovascular Risk Factors Human Retrospective Design Record Review Middle Age Male Female Cox Proportional Hazards Model Myocardial Infarction Risk Factors Stroke Risk Factors Myocardial Revascularization Prospective Studies Descriptive Statistics Exploratory Research Data Analysis Software Middle Aged: 45-64 years Male Female ab: • ApoB/LDL-C discordance associates with ASCVD risk in HeFH. • High ApoB/LDL-C ratios correlate with increased event rates. • rdance captures residual risk missed by LDL-C alone. • Findings support ApoB use for HeFH risk stratification. In heterozygous familial hypercholesterolemia (HeFH), low-density lipoprotein cholesterol (LDL-C) remains the primary treatment target, yet emerging evidence suggests apolipoprotein B (ApoB) may offer superior cardiovascular risk stratification. ApoB/LDL-C discordance occurs when ApoB and LDL-C provide conflicting risk information, potentially identifying patients at heightened atherosclerotic cardiovascular disease (ASCVD) risk despite apparently controlled LDL-C levels. However, evidence in genetically confirmed HeFH cohorts is sparse. To examine whether ApoB/LDL-C discordance associates with ASCVD events in a genetically confirmed HeFH cohort and to generate hypotheses for future validation studies. This retrospective cohort study included 424 genetically confirmed HeFH patients (median age 51 years, 54.5% female) followed for a median of 9.1 years. Patients were classified as concordant (both ApoB and LDL-C above or below sex-specific thresholds) or discordant. Cox proportional hazards models evaluated associations with ASCVD events (myocardial infarction, stroke, coronary revascularization), adjusting for age, sex, diabetes, hypertension, smoking, statin therapy, and baseline lipid parameters. Among 424 patients, 61 ASCVD events occurred (41 prevalent, 20 incident). ApoB/LDL-C ratio ≥0.31 g/mmol associated with higher event rates (27.6% vs 11.8%, P =.0022). Adjusted hazard ratio was 38.55 (95% CI 3.72-399.36), though marked by extreme instability from sparse data stratification and small event counts. Additional exploratory analyses using R software revealed linear correlation patterns and threshold-based associations supporting the discordance hypothesis. These preliminary findings suggest ApoB/LDL-C discordance may identify residual ASCVD risk in HeFH patients, warranting prospective validation in larger, independent cohorts before clinical application. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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