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Which Lipids Mark MI Risk Best?
When used to estimate risk for acute myocardial infarction, the nonfasting apolipoprotein B/A-1 ratio may do better than other lipid measurements (and their ratios), Lancet reports.
Investigators for the INTERHEART study analyzed nonfasting lipids from some 9300 cases with first-instance acute MI and over 12,000 age- and sex-matched controls from 52 countries.
The apo B/apo A-1 ratio held the highest predictive value — significantly higher than the predictive value of the LDL/HDL ratio and the total cholesterol/HDL ratio. The results were consistent across ethnicity, sex, and age.
The authors say their results "provide broad and straightforward support that [the ratio] should be introduced worldwide into clinical practice." A commentator agrees, noting however, that "the most important task is to ascertain that lipids are evaluated at all."
LINK(S):
Lancet article (Free abstract; full text requires subscription)
Lancet comment (Subscription required)
American Diabetes Association/American College of Cardiology lipoprotein guidelines (Free)
Published in Physician's First Watch July 18, 2008
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