The apoB/apoA-I ratio: a strong, new risk factor for cardiovascular disease and a target for lipid-lowering therapy--a review of the evidence

J Intern Med. 2006 May;259(5):493-519. doi: 10.1111/j.1365-2796.2006.01643.x.


During the last several years interest has focused on the importance of the lipid-transporting apolipoproteins--apoB transports all potentially atherogenic very low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL) and LDL particles, and apoA-I transports and acts as the major antiatherogenic protein in the HDL particles. The evidence for the apoB/apoA-I ratio being a strong, new risk factor for cardiovascular (CV) disease and a target for lipid-lowering therapy is reviewed. Results from clinical prospective studies and lipid-lowering trials in healthy subjects and in patients with different clinical manifestations of atherosclerosis are reported. Risk of nonfatal and fatal myocardial infarction and stroke, and manifestations of atherosclerosis documented by angiographic, ultrasound and other techniques has been related to conventional lipids and apolipoproteins (apo). The cholesterol balance determined as the apoB/apoA-I ratio has repeatedly been shown to be a better marker than lipids, lipoproteins and lipid ratios. The results indicate that the apoB/apoA-I ratio is a simple, accurate and new risk factor for CV disease--the lower the apoB/apoA-I ratio, the lower is the risk. Guidelines should be developed in order to recognize the important clinical risk information embedded in the apoB/apoA-I ratio.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anticholesteremic Agents / therapeutic use*
  • Apolipoprotein A-I / blood*
  • Apolipoproteins B / blood*
  • Atherosclerosis / blood
  • Atherosclerosis / physiopathology
  • Biomarkers / blood
  • Cardiovascular Diseases / blood*
  • Cardiovascular Diseases / physiopathology
  • Cardiovascular Diseases / prevention & control
  • Cholesterol / blood
  • Diabetic Angiopathies / blood
  • Female
  • Humans
  • Lipoproteins / blood
  • Male
  • Metabolic Syndrome / blood
  • Myocardial Infarction / blood
  • Myocardial Infarction / mortality
  • Prospective Studies
  • Risk Factors
  • Stroke / blood


  • Anticholesteremic Agents
  • Apolipoprotein A-I
  • Apolipoproteins B
  • Biomarkers
  • Lipoproteins
  • Cholesterol