Apolipoprotein test best predictor of heart attack

Doubt cast on cholesterol ratios for estimating risk of MI.

Doctors have been urged to ditch cholesterol ratios when estimating MI risk and look at apolipoproteins instead.

Apolipoprotein B100 (ApoB)/apolipoprotein A1 (ApoA1) is superior to any cholesterol ratio in predicting acute MI in all ethnic groups, according to an international case-control study involving over 20,000 patients from 52 countries.

Findings from the INTERHEART study add to the argument for the ApoB/ApoA1 ratio to become the norm in cardiovascular assessment.

For the latest study non-fasting blood samples were taken from 9,345 patients with a first acute MI and 12,120 age- and sex-matched controls.

Concentrations of plasma lipids, lipoproteins and apolipoprotein ratios were calculated, alongside the risk of MI.

The ApoB/ApoA1 ratio accounted for 54 per cent of the risk of MI.

In contrast, LDL/HDL cholesterol ratio accounted for 37 per cent of the risk, and total/HDL-cholesterol 32 per cent.

The finding was consistent across all age groups, ethnic groups and men and women.

Moreover, ApoB/ApoA1 ratio was consistently better than total/HDL cholesterol even with a long delay between eating and taking blood.

This could mean apolipoproteins are better markers of MI risk even after a 12-hour fast.

Professor John Sanderson from the University of Birmingham, who was involved in the study, told GP: 'There are certain advantages of the apolipoproteins.

'Firstly, they are a better predictor of MI and secondly they are not affected by fasting.'

However, he added: 'It would require a big shift of concepts because the HDL/LDL ratio is fully ingrained.'

rachel.liddle@haymarket.com

Lancet 2008; 372: 216-32

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