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Interpretive Handbook

Test 80308 :
Apolipoprotein B, Plasma

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Apolipoprotein B (ApoB) is the primary protein component of low-density lipoprotein (LDL). LDL contains a variable amount of cholesterol, but each LDL contains exactly 1 ApoB protein. Therefore, ApoB is a superior indicator of circulating LDL compared to LDL cholesterol (LDL-C). ApoB has been demonstrated to perform equally with LDL particles measured by nuclear magnetic resonance spectroscopy.(1)

 

ApoB is strongly associated with increased risk of developing cardiovascular disease (CVD) and often outperforms LDL-C at predicting risk of coronary heart disease.(2-4) Patients with acceptable non-HDL-C (or LDL-C) but elevated ApoB remain at higher risk of developing CVD; conversely, patients with acceptably low ApoB but moderate non-HDL-C or LDL-C elevations are at a reduced risk for CVD.(5,6) Finally, in 7 different placebo-controlled randomized clinical trials, on-statin reduction of ApoB was more closely related to CVD risk reduction than non-HDL-C or LDL-C.(7)

Useful For Suggests clinical disorders or settings where the test may be helpful

Assessment of residual risk in patients at target non high-density lipoprotein-cholesterol (HDL-C) (or low-density lipoprotein-cholesterol: LDL-C)

 

Follow-up studies in individuals with non-HDL-C (or LDL-C) values inconsistent with risk factors or clinical presentation

 

Definitive studies of cardiac risk factors in individuals with significant family histories of coronary artery disease or other increased risk factors

 

Confirmation of suspected abetalipoproteinemia or hypobetalipoproteinemia

Interpretation Provides information to assist in interpretation of the test results

Elevated ApoB confers increased risk of coronary artery disease ApoB can be used as a therapeutic target analogous to non-HDL-C and LDL-C.

 

Risk Category

Therapeutic Target:

ApoB

Non-HDL-C

LDL-C

Moderate to High

<90 mg/dL

<130 mg/dL

<100 mg/dL

Very High

<80 mg/dL

<100 mg/dL

<70 mg/dL

 

Extremely low values of ApoB (<48 mg/dL) are related to malabsorption of food lipids and can lead to polyneuropathy.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

 

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

Age

Apolipoprotein B (mg/dL)

<24 months

Not established

2-17 years

Acceptable: <90

Borderline high: 90-109

High: > or =110

>18 years

Desirable: <90

Above Desirable: 90-99

Borderline high: 100-119

High: 120-139

Very high: > or =140

Clinical References Provides recommendations for further in-depth reading of a clinical nature

1. Cole TG, Contois JH, Csako G, et al: Association of apolipoprotein B and nuclear magnetic resonance spectroscopy-derived LDL particle number with outcomes in 25 clinical studies: assessment by the AACC Lipoprotein and Vascular Diseases Division Working Group on best practices. Clin Chem 2013;59:752-770

2. Sierra-Johnson J, Fisher RM, Romero-Corral A, et al: Concentration of apolipoprotein B is comparable with the apolipoprotein B/apolipoprotein A-I ratio and better than routine clinical lipid measurements in predicting coronary heart disease mortality: findings from a multi-ethnic US population. Eur Heart J 2009;30(6):710-717

3. Steffen BT, Guan W, Remaley AT, et al: Use of lipoprotein particle measures for assessing coronary heart disease risk Post-American Heart Association / American College of Cardiology Guidelines: The Multi-Ethnic Study of Atherosclerosis. Arterioscler Thromb Vasc Biol 2015;35:448-454

4. Thompson A, Danesh J: Associations between apolipoprotein B, apolipoprotein AI, the apolipoprotein B/AI ratio and coronary heart disease: a literature-based meta-analysis of prospective studies. J Intern Med 2006;259:481-492

5. Mora S, Buring JE, Ridker PM: Discordance of low-density lipoprotein (LDL) cholesterol with alternative LDL-related measures and future coronary events. Circulation 2014;129:553-561

6. Pencina MJ, D'Agostino RB, Zdrojewski T, et al: Apolipoprotein B improves risk assessment of future coronary heart disease in the Framingham Heart Study beyond LDL-C and non-HDL-C. Eur J Prev Cardiol 2015;epub ahead of print

7. Thanassoulis G, Williams K, Ye K, et al: Relations of change in plasma levels of LDL-C, non-HDL-C and apoB with risk reduction from statin therapy: a meta-analysis of randomized trials. J Am Heart Assoc 2014;3:e000759

8. Jacobson TA, Ito MK, Maki KC, et al: National Lipid Association recommendations for patient-centered management of dyslipidemia: Part 1-executive summary. J Clin Lipidol 2014 Sep-Oct;8(5):473-488

9. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics 2011 Dec;128 Suppl 5:S213-S256

10. Contois JH, McConnell JP, Sethi AA, et al: Apolipoprotein B and Cardiovascular Disease Risk: Position Statement from the AACC Lipoproteins and Vascular Diseases Division Working Group on Best Practices. Clinical Chemistry 2009:55:3:407-419


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