Apolipoprotein levels no better than standard methods to evaluate CVD risk

Clinical Question

Are apolipoprotein levels and ratios useful in predicting the risk of coronary heart disease?

Bottom Line

Measurement of the apolipoprotein B:apolipoprotein A-I ratio is comparable with, but does not offer any incremental utility to, standard lipid level ratios in predicting coronary heart disease (CHD). Routine measurement of apolipoprotein levels in clinical practice should be discouraged. (LOE = 1b)


Ingelsson E, Schaefer EJ, Contois JH, et al. Clinical utility of different lipid measures for prediction of coronary heart disease in men and women. JAMA 2007;298:776-785.  [PMID:17699011]

Study Design

Cohort (prospective)






Controversy exists regarding the value of measuring apolipoprotein levels for predicting CHD risk. As part of the Framingham Offspring Study, these investigators prospectively followed 3322 white adults (53% female), aged 30 to 74 years, initially attending an examination cycle from 1987 to 1991. Baseline evaluation included measuring standard lipid levels (total cholesterol, HDL cholesterol, LDL cholesterol), as well as non-HDL cholesterol, apolipoprotein A-I, and apolipoprotein B. None of the participants had cardiovascular disease at the beginning of the study. Three individuals assessed outcomes after review of hospital and physician office visit records; the authors do not specifically state if they were masked to baseline lipid levels. After a median of 15 years of follow-up, 291 subjects (198 men) developed CHD. Using multivariate prediction models adjusting for nonlipid risk factors, the apolipoprotein B:apolipoprotein A-I ratio was comparable with, without any incremental utility to, other standard lipid level ratios (eg, total cholesterol:HDL-cholesterol ratio) in predicting CHD.