| Title: | Excess apolipoprotein B predicts long-term survival in statin-treated CAD irrespective of achieved LDL-C levels: a pooled cohort analysis |
| Journal: | Lipids in Health and Disease |
| Published: | 24 Mar 2026 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/41877106/ |
| DOI: | https://doi.org/10.1186/s12944-026-02928-z |
Publication 18221
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Abstract
BackgroundResidual cardiovascular risk persists in statin-treated patients with coronary artery disease (CAD), even when low-density lipoprotein cholesterol (LDL-C) targets are met. Excess apolipoprotein B (apoB), defined as measured apoB minus LDL-C-predicted apoB, may capture atherogenic particle burden beyond LDL-C, but its prognostic value for long-term mortality in secondary prevention remains uncertain.MethodsWe conducted a pooled analysis of two nationwide Chinese cohorts (CIN-II and RED-CARPET) comprising 68,616 statin-treated CAD patients. Excess apoB was calculated using an internal reference population (triglycerides ≤ 1.0 mmol/L). Associations with all-cause and cardiovascular mortality were assessed using multivariable Cox models, with adjustment for clinical covariates including nutritional status. External validation was performed in 13,702 participants from the UK Biobank.ResultsOver a median follow-up of 5.2 years, 10,835 deaths occurred (5,090 cardiovascular). Each 1-standard deviation (15.4 mg/dL) increase in excess apoB was associated with a 12% higher risk of all-cause mortality (adjusted hazard ratio [aHR] 1.12, 95% CI 1.06-1.18) and a 24% higher risk of cardiovascular mortality (aHR 1.24, 95% CI 1.15-1.34). Patients in the highest excess apoB quartile (≥ 11.5 mg/dL) had significantly worse survival. Notably, these associations persisted consistently across all achieved LDL-C strata (< 2.0 to > 4.0 mmol/L). These findings were robustly confirmed in the external validation cohort.ConclusionsExcess apoB is an independent predictor of long-term mortality in statin-treated CAD patients, even among those with well-controlled LDL-C. Its incorporation into risk assessment could improve prognostic stratification and guide personalized management in secondary prevention.Trial registrationCIN-II: ClinicalTrials.gov, NCT05050877 (Retrospectively registered, 21 September 2021); RED-CARPET: Chinese Clinical Trial Registry, ChiCTR2000039901 (Prospectively registered, 14 November 2020). The UK Biobank study is covered by generic ethical approval from the NHS National Research Ethics Service (Ref: 99231).</p>
17 Authors
- Wei Pan
- Xiaozhao Lu
- Ziwei Zhou
- Jin Liu
- Shaozhao Zhang
- Haozhang Huang
- Yibo He
- Jingru Deng
- Yihang Ling
- Xianlin Ruan
- Ling Jing
- Weipeng Zhang
- Shiqun Chen
- Xinxue Liao
- Jiyan Chen
- Xiaodong Zhuang
- Yong Liu
1 Application
| Application ID | Title |
|---|---|
| 99231 | The association between cardiac dysfunction and novel risk factors in chronic kidney disease |
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