Apolipoprotein B predicts risk for acute coronary syndrome in patients with metabolic syndrome

Background: In patients with metabolic syndrome, low-density lipoprotein cholesterol (LDL-C) may not be an accurate reflection of atherogenic burden. Studies show apolipoprotein B (apoB) better predicts CV events over LDL-C and non-high-density lipoprotein cholesterol (non-HDL-C). We compared LDL-C, non-HDL-C and apoB as predictors for acute coronary syndrome (ACS) in patients with metabolic syndrome. Methods: We performed a retrospective case-control study on patients presenting to our hospital with ACS, based on admitting and discharge diagnosis. A multivariate logistic regression analysis was used to determine if LDL-C, non-HDL-C and Apo B were independent risk factors for ACS. Receiver-operating curves (ROC) comparison was done to determine the individual predictive values for ACS. Results: From 269 patients (63±14.3years, 52.8% men), 35.3% had metabolic syndrome based on WHO criteria. ApoB was found to be the only significant independent risk factor for predicting ACS (OR 1.54, 95% CI 1-2.36, p=0.036). ROC comparison revealed apoB had the highest area under the curve (AUC) with a non-significant trend towards having the strongest performance measure for predicting ACS (Figure). In contrast, all other lipid measures were not significant independent risk factors in patients without metabolic syndrome. ![Figure][1] Conclusion: ApoB had the strongest association with ACS, which may support the utility of apoB as a better predictor for CV events in patients with metabolic syndrome. Future studies of apolipoprotein-based risk prediction models may be warranted given current lipid guidelines may underestimate CV risk in this patient population. [1]: pending:yes