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)

J Clin Lipidol. 2020 Jan-Feb;14(1):109-121.e5. doi: 10.1016/j.jacl.2019.11.005. Epub 2019 Nov 29.


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.

Keywords: Apolipoprotein B; Coronary artery calcium; Discordance; Low-density lipoprotein cholesterol; Non-high-density lipoprotein cholesterol.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Apolipoproteins B / blood*
  • Atherosclerosis / blood*
  • Atherosclerosis / metabolism
  • Atherosclerosis / pathology
  • Cholesterol / blood
  • Cholesterol, HDL / blood
  • Cholesterol, LDL / blood*
  • Coronary Artery Disease / blood*
  • Coronary Artery Disease / epidemiology
  • Coronary Artery Disease / pathology
  • Coronary Vessels / metabolism
  • Coronary Vessels / pathology
  • Female
  • Humans
  • Lipids / blood
  • Male
  • Metabolic Syndrome / blood
  • Metabolic Syndrome / metabolism
  • Metabolic Syndrome / pathology
  • Middle Aged
  • Odds Ratio
  • Risk Assessment
  • Vascular Calcification / blood*
  • Vascular Calcification / metabolism
  • Vascular Calcification / pathology


  • Apolipoproteins B
  • Cholesterol, HDL
  • Cholesterol, LDL
  • Lipids
  • Cholesterol