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.'
Lancet 2008; 372: 216-32
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