Apolipoprotein B discordance with low-density lipoprotein cholesterol and non–high-density lipoprotein cholesterol in relation to coronary artery calcification in the Multi-Ethnic Study of Atherosclerosis (MESA)

Jing Cao, Sarah O. Nomura, Brian T. Steffen, Weihua Guan, Alan T. Remaley, Amy B. Karger, Pamela Ouyang, Erin D. Michos, Michael Y. Tsai

Research output: Contribution to journalArticle


Background: Discordant levels of apolipoprotein B (apo B) relative to low-density lipoprotein cholesterol (LDL-C) or non–high-density lipoprotein cholesterol (non-HDL-C) may be associated with subclinical atherosclerotic cardiovascular disease (ASCVD). Objective: The present study investigated whether discordance between apo B and LDL-C or non-HDL-C levels was associated with subclinical ASCVD measured by coronary artery calcium (CAC). Methods: This study was conducted in a subpopulation of the Multi-Ethnic Study of Atherosclerosis (MESA) cohort, aged 45 to 84 years, free of ASCVD, and not taking lipid-lowering medications at the baseline (2000–2002) (prevalence analytic N = 4623; incidence analytic N = 2216; progression analytic N = 3947). Apo B discordance relative to LDL-C and non-HDL-C was defined using residuals and percentile rankings (>5/10/15 percentile). Associations with prevalent and incident CAC (CAC > 0 vs CAC = 0) were assessed using prevalence ratio/relative risk regression and CAC progression (absolute increase/year) using multinomial logistic regression. Results: Higher apo B levels were associated with CAC prevalence, incidence, and progression. Apo B discordance relative to LDL-C or non-HDL-C was inconsistently associated with CAC prevalence and progression. Discordantly high apo B relative to LDL-C and non-HDL-C was associated with CAC progression. Associations for apo B discordance with non-HDL-C remained after further adjustment for metabolic syndrome components. Conclusion: Apo B was associated with CAC among adults aged ≥45 years not taking statins, but provided only modest additional predictive value of apo B for CAC prevalence, incidence, or progression beyond LDL-C or non-HDL-C. Apo B discordance may still be important for ASCVD risk assessment and further research is needed to confirm findings.

Original languageEnglish (US)
Pages (from-to)109-121.e5
JournalJournal of Clinical Lipidology
Issue number1
StatePublished - Jan 1 2020



  • Apolipoprotein B
  • Coronary artery calcium
  • Discordance
  • Low-density lipoprotein cholesterol
  • Non-high-density lipoprotein cholesterol

PubMed: MeSH publication types

  • Journal Article

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