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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

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Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter

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Volume 42, Issue 12


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

Göran Walldius
  • King Gustaf V Research Institute, Karolinska Institute, Stockholm, Sweden and AstraZeneca, Molndal, Sweden
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Ingmar Jungner / Are H. Aastveit
  • Department of Chemistry, Biotechnology and Food Science, Agricultural University of Norway, As, Norway
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Ingar Holme / Curt D. Furberg / Allan D. Sniderman
  • Mike Rosenblom Laboratory for Cardiovascular Research, McGill University Health Center, McGill University, Montreal, QC, Canada
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2005-06-01 | DOI: https://doi.org/10.1515/CCLM.2004.254


Background: The apolipoprotein B (apoB)/apoA-I ratio represents the balance of proatherogenic and antiatherogenic lipoproteins. The purpose of this study was to determine whether the apoB/apoA-I ratio was superior to any of the cholesterol ratios – total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C), low-density lipoprotein cholesterol (LDL-C)/HDL-C and non-HDL-C/HDL-C – in predicting the risk of coronary disease. Moreover, we examined whether any lipids, lipoproteins or cholesterol ratios add significant predictive information beyond that provided by the apoB/apoA-I ratio.

Methods: Plasma lipids, lipoproteins, apoB, and apoA-I were measured in 69,030 men and 57,168 women above 40years of age. After a mean follow-up of 98months, 1183 men and 560 women had died from a myocardial infarction in this prospective apolipoprotein-related mortality risk (AMORIS) study.

Results: High apoB and a high apoB/apoA-I ratio were strongly related to increased coronary risk, while high apoA-I was inversely related to risk. The apoB/apoA-I ratio was superior to any of the cholesterol ratios in predicting risk. This advantage was most pronounced in subjects with LDL-C levels <3.6mmol/l. Addition of lipids, lipoproteins or any cholesterol ratio to apoB/apoA-I in risk models did not further improve the strong predictive value of apoB/apoA-I.

Conclusions: These results indicate that the apoB/apoA-I ratio is at present the best single lipoprotein-related variable to quantitate coronary risk. Given the additional advantages apolipoproteins possess – fasting samples are not required, apoB/apoA-I is a better index of the adequacy of statin therapy than LDL-C, and the measurement of apoB and apoA-I are standardized, whereas LDL-C and HDL-C are not – there would appear to be considerable advantage to integrating apolipoproteins into clinical practice.

Keywords: apolipoprotein A-I; apolipoprotein B; fatal myocardial infarction; guidelines; lipoproteins


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About the article

Corresponding author: Prof. G. Walldius, AstraZeneca, 431 83 Molndal, Sweden Phone: +46-31-7762678, Fax: +46-31-7763802,

Received: 2004-08-18

Accepted: 2004-10-05

Published Online: 2005-06-01

Published in Print: 2004-12-01

Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 42, Issue 12, Pages 1355–1363, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/CCLM.2004.254.

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Haïfa Mahjoub, Patrick Mathieu, Mario Sénéchal, Eric Larose, Jean Dumesnil, Jean-Pierre Després, and Philippe Pibarot
Journal of the American College of Cardiology, 2013, Volume 61, Number 7, Page 752
Jae-Hong Ryoo
American Journal of Kidney Diseases, 2013, Volume 61, Number 4, Page 564
Qianqian Yin, Xiaoli Chen, Lin Li, Ran Zhou, Jia Huang, and Dongzi Yang
Journal of Obstetrics and Gynaecology Research, 2013, Volume 39, Number 1, Page 203
S. Mathieu, B. Pereira, J.-J. Dubost, J.-R. Lusson, and M. Soubrier
Rheumatology, 2012, Volume 51, Number 6, Page 1107
Manoj Kumar, Ravinder Nagpal, Rajesh Kumar, R. Hemalatha, Vinod Verma, Ashok Kumar, Chaitali Chakraborty, Birbal Singh, Francesco Marotta, Shalini Jain, and Hariom Yadav
Experimental Diabetes Research, 2012, Volume 2012, Page 1
Ingmar Jungner, Allan D. Sniderman, Curt Furberg, Are H. Aastveit, Ingar Holme, and Goran Walldius
The American Journal of Cardiology, 2006, Volume 97, Number 7, Page 943
Ingar Holme, Kurt Boman, Philippe Brudi, Kenneth Egstrup, Christa Gohlke-Baerwolf, Y. Antero Kesäniemi, William Malbecq, Anne B. Rossebø, Kristian Wachtell, Ronnie Willenheimer, and Terje R. Pedersen
The American Journal of Cardiology, 2010, Volume 105, Number 12, Page 1802
Justo Sierra-Johnson, Virend Kristen Somers, Fatima Helena Sert Kuniyoshi, Carolina Ana Garza, William Luther Isley, Apoor Suresh Gami, and Francisco Lopez-Jimenez
The American Journal of Cardiology, 2006, Volume 98, Number 10, Page 1369
Martin J. Holzmann, Ingmar Jungner, Göran Walldius, Torbjörn Ivert, Tobias Nordqvist, Jan Östergren, and Niklas Hammar
Annals of Medicine, 2012, Volume 44, Number 3, Page 262
S. Lundberg, I. Gunnarsson, and S. H. Jacobson
Scandinavian Journal of Urology and Nephrology, 2012, Volume 46, Number 2, Page 148
A. Onat, G. Hergenç, S. Bulur, M. Uğur, Z. Küçükdurmaz, and G. Can
International Journal of Cardiology, 2010, Volume 142, Number 1, Page 72
Nicolás Terrados, Gracia Valcárcel, and Rafael Venta
Apunts. Medicina de l'Esport, 2010, Volume 45, Number 167, Page 201
Allan D. Sniderman and Santica M. Marcovina
Clinics in Laboratory Medicine, 2006, Volume 26, Number 4, Page 733
Helen M. Heneghan, Hazel Huang, Sangeeta R. Kashyap, Heather L. Gornik, Arthur J. McCullough, Philip R. Schauer, Stacy A. Brethauer, John P. Kirwan, and Takhar Kasumov
Surgery for Obesity and Related Diseases, 2013, Volume 9, Number 1, Page 100
Shali Xie, Jundong Zhu, Yanqi Zhang, Kai Shi, Yuangang Shi, and Xiao Ma
British Journal of Nutrition, 2012, Volume 108, Number 04, Page 603
M. M. Ould Mohamedou, K. Zouirech, M. El Messal, M. S. El Kebbaj, A. Chraibi, and A. Adlouni
International Journal of Endocrinology, 2011, Volume 2011, Page 1
Jesús Millán, Xavier Pintó, Anna Muñoz, Manuel Zúñiga, Joan Rubiés-Prat, Luis Felipe Pallardo, Luis Masana, Alipio Mangas, Antonio Hernández Mijares, Pedro González Santos, Juan F. Ascaso, and Juan Pedro-Botet
Clínica e Investigación en Arteriosclerosis, 2010, Volume 22, Number 1, Page 25
Adriano Paula Sabino, Marinez De Oliveira Sousa, Luciana Moreira Lima, Daniel Dias Ribeiro, Luci Maria Sant'Ana Dusse, Maria Das Graças Carvalho, and Ana Paula Fernandes
Translational Research, 2008, Volume 152, Number 3, Page 113
Göran Walldius and Ingmar Jungner
Nutrition, Metabolism and Cardiovascular Diseases, 2007, Volume 17, Number 8, Page 565
Angeliki Triantafyllou, Nikolaos Chaviaras, Theodoros N. Sergentanis, Evaggelia Protopapa, and John Tsaknis
Journal of Ethnopharmacology, 2007, Volume 111, Number 1, Page 43
Sunčica Kojić-Damjanov, Mirjana đerić, Velibor Čabarkapa, and Ljiljana Vučurević-Ristić
Journal of Medical Biochemistry, 2007, Volume 26, Number 3
Michel R. Langlois and Victor H. Blaton
Clinica Chimica Acta, 2006, Volume 369, Number 2, Page 168
Li Tian, Xinwei Wu, Mingde Fu, Yang Qin, Yanhua Xu, and Lianqun Jia
Clinica Chimica Acta, 2008, Volume 388, Number 1-2, Page 148
Chung-Yu Chang, Yung-Chieh Tsai, Chien-Hung Lee, Te-Fu Chan, Shih-Han Wang, and Juin-Huang Su
Fertility and Sterility, 2011, Volume 95, Number 8, Page 2520
Hamilton M. Hinuy, Mario H. Hirata, Marcelo F. Sampaio, Dikran Armaganijan, Luis A. Salazar, and Rosario D.C. Hirata
Molecular Genetics and Metabolism, 2006, Volume 89, Number 4, Page 374
I. Gambardella, P.H. Blair, A. McKinley, R. Baker, and D.W. Harkin
European Journal of Vascular and Endovascular Surgery, 2011, Volume 41, Number 2, Page 249
Charlotte Ebeling Barbier, Lars Lind, Håkan Ahlström, Anders Larsson, and Lars Johansson
Atherosclerosis, 2010, Volume 211, Number 2, Page 656
Ganesan Karthikeyan, Koon K. Teo, Shofiqul Islam, Mathew J. McQueen, Prem Pais, Xingyu Wang, Hiroshi Sato, Chim Choy Lang, Chitr Sitthi-Amorn, M.R. Pandey, Khawar Kazmi, John E. Sanderson, and Salim Yusuf
Journal of the American College of Cardiology, 2009, Volume 53, Number 3, Page 244
Michael H. Davidson
The American Journal of Cardiology, 2007, Volume 99, Number 4, Page 41
Åsa Lindholm, Marie Bixo, Inger Björn, Pål Wölner-Hanssen, Mats Eliasson, Anders Larsson, Owe Johnson, and Inger Sundström Poromaa
Fertility and Sterility, 2008, Volume 89, Number 5, Page 1221
Matthew J McQueen, Steven Hawken, Xingyu Wang, Stephanie Ounpuu, Allan Sniderman, Jeffrey Probstfield, Krisela Steyn, John E Sanderson, Mohammad Hasani, Emilia Volkova, Khawar Kazmi, and Salim Yusuf
The Lancet, 2008, Volume 372, Number 9634, Page 224
Lars H. Breimer and D.P. Mikhailidis
Current Medical Research and Opinion, 2010, Volume 26, Number 11, Page 2701
Vladimir Soska, Jindrich Fiala, Katerina Nebeska, Jiri Jarkovsky, and Drahoslava Hruba
Scandinavian Journal of Clinical and Laboratory Investigation, 2011, Volume 71, Number 2, Page 94
Mehdi Rasouli, Asadollah Mohseni Kiasari, and Vahid Mokhberi
Clinical Chemistry and Laboratory Medicine (CCLM), 2006, Volume 44, Number 8
Anna Maisa, Clare Westhorpe, Julian Elliott, Anthony Jaworowski, Anna C Hearps, Anthony M Dart, Jennifer Hoy, and Suzanne M Crowe
HIV Therapy, 2010, Volume 4, Number 6, Page 675
Li Zhong, Qifu Li, Yuanjuan Jiang, Dan Cheng, Zhoujun Liu, Bangqiong Wang, Rong Luo, Qingfeng Cheng, and Hua Qing
Inflammation, 2010, Volume 33, Number 6, Page 353
O Ben Ounis, M Elloumi, E Makni, H Zouhal, M Amri, Z Tabka, and G Lac
Acta Paediatrica, 2010, Volume 99, Number 11, Page 1679
Mia Hedman, Raija Pahlman, Jouko Sundvall, Christian Ehnholm, Mikko Syvänne, Eero Jokinen, Matti Jauhiainen, Christer Holmberg, and Marjatta Antikainen
Pediatric Transplantation, 2007, Volume 11, Number 5, Page 481
J. R. H. Raiko, J. S. A. Viikari, A. Ilmanen, N. Hutri-Kähönen, L. Taittonen, E. Jokinen, M. Pietikäinen, A. Jula, B.-M. Loo, J. Marniemi, T. Lehtimäki, M. Kähönen, T. Rönnemaa, O. T. Raitakari, and M. Juonala
Journal of Internal Medicine, 2010, Volume 267, Number 4, Page 370
Amirhosein Khoshi, Yousof Mortazavi, Abbass Akbari, Sepideh Sokhanvar, and Sadraddin Kalantari
Indian Journal of Clinical Biochemistry, 2009, Volume 24, Number 4, Page 381
Riza C Ozsoy, Sander I van Leuven, John JP Kastelein, Lambertus Arisz, and Marion G Koopman
Current Opinion in Lipidology, 2006, Volume 17, Number 6, Page 659
Robert D. Brook, Hardik Doshi, Robert L. Bard, and Melvyn Rubenfire
Clinical Cardiology, 2009, Volume 32, Number 5, Page 251
S. Yuditskaya, A. Tumblin, G. T. Hoehn, G. Wang, S. K. Drake, X. Xu, S. Ying, A. H. Chi, A. T. Remaley, R.-F. Shen, P. J. Munson, A. F. Suffredini, and G. J. Kato
Blood, 2008, Volume 113, Number 5, Page 1122
J. Sierra-Johnson, R. M. Fisher, A. Romero-Corral, V. K. Somers, F. Lopez-Jimenez, J. Ohrvik, G. Walldius, M.-L. Hellenius, and A. Hamsten
European Heart Journal, 2008, Volume 30, Number 6, Page 710
Shirley C. Chen, Joseph T. Judd, Matthew Kramer, Gert W. Meijer, Beverly A. Clevidence, and David J. Baer
Lipids, 2009, Volume 44, Number 3, Page 273
I. Holme, A. H. Aastveit, N. Hammar, I. Jungner, and G. Walldius
Journal of Internal Medicine, 2009, Volume 265, Number 2, Page 275
Lucia Agoston-Coldea, Teodora Mocan, Marc Gatfossé, and Dan Dumitrascu
Open Medicine, 2008, Volume 3, Number 4
Irene F. Gazi, Haralampos J. Milionis, Theodosios D. Filippatos, Vasilis Tsimihodimos, Michael S. Kostapanos, Michael Doumas, Alexandros D. Tselepis, and Moses Elisaf
Diabetes/Metabolism Research and Reviews, 2008, Volume 24, Number 3, Page 223
Allan D. Sniderman and Robert S. Kiss
Current Atherosclerosis Reports, 2007, Volume 9, Number 4, Page 261
G??ran Walldius and Ingmar Jungner
Current Opinion in Cardiology, 2007, Volume 22, Number 4, Page 359
Kan-Zhi Liu, Angela Man, Thomas C. Dembinski, and R. Anthony Shaw
Analytical and Bioanalytical Chemistry, 2007, Volume 387, Number 5, Page 1809
S. M. Marcovina, F. Crea, J. Davignon, J. C. Kaski, W. Koenig, U. Landmesser, P. L. Pieri, J. Schulz-Menger, L. J. Shaw, and J. Sobesky
Journal of Internal Medicine, 2007, Volume 261, Number 3, Page 214
Débora Vieira Soares, Luciana Diniz Carneiro Spina, Rosane Resende de Lima Oliveira Brasil, Priscila Marise Lobo, Elizabeth Salles, Claúdia Medina Coeli, Flávia Lúcia Conceição, and Mario Vaisman
Pituitary, 2006, Volume 9, Number 2, Page 127
Journal of Internal Medicine, 2006, Volume 259, Number 5, Page 455
Journal of Internal Medicine, 2006, Volume 259, Number 3, Page 259
Journal of Internal Medicine, 2006, Volume 259, Number 3, Page 247
Journal of Internal Medicine, 2005, Volume 257, Number 6, Page 531

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