Risk-weighted apoB and lipoprotein-associated coronary risk across ethnic groups

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ID: 332659
2026
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Abstract
AIMS: Apolipoprotein B (apoB) reflects the number of circulating atherogenic lipoproteins but does not account for differences in particle atherogenicity. Risk-weighted apoB (RW-apoB), which incorporates triglyceride-rich lipoproteins and lipoprotein(a) (Lp(a)), may better capture lipoprotein-driven coronary risk, but its performance across diverse populations remains uncertain. We assessed whether the prespecified triglyceride - and Lp(a)-weighted information captured by RW-apoB was associated with coronary events beyond apoB and compared the discrimination of RW-apoB and measured apoB across ethnicities. METHODS: We analyzed 40,132 participants with 4,509 coronary events from ARIC, CARDIA, MESA, the Framingham Offspring Study, and China Kadoorie Biobank. RW-apoB was calculated using a prespecified equation. Mutually adjusted Cox estimates were pooled within ethnic groups using random-effects meta-analysis. Separate single-marker models compared discrimination. Sensitivity analyses included age and sex adjustment, standardized exposures, hard-events, truncated follow-up, and CKB-specific logistic regression. RESULTS: Mean RW-apoB exceeded apoB by approximately 8 mg/dL in African American and Chinese participants, reflecting higher lipoprotein(a) and triglycerides, respectively. RW-apoB was associated with coronary events conditional on apoB in White, African American, Chinese, and Hispanic participants: hazard ratios per 10 mg/dL were 1.11 (95% CI 1.05-1.18), 1.11 (1.08-1.15), 1.08 (1.05-1.11), and 1.10 (1.01-1.21), respectively. C-indices for RW-apoB versus apoB were 0.630 versus 0.617 in White (P<0.001), 0.606 versus 0.595 in African American (P=0.085), 0.567 versus 0.554 in Chinese (P=0.014), and 0.540 versus 0.535 in Hispanic participants (P=0.756). CONCLUSION: RW-apoB captured lipoprotein-associated risk beyond measured apoB, with discrimination gains statistically demonstrable in the larger White and Chinese groups.
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openalex_W7222813512 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Michaela Beatrice Rehman, Elias Björnson
Journal european journal of preventive cardiology
Year 2026
DOI
10.1093/eurjpc/zwag547
URL
https://doi.org/10.1093/eurjpc/zwag547
Keywords Keywords not found

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