Abstract Th0013: Apolipoprotein B and C-Reactive Protein Identifies High Cardiovascular Risk More Effectively Than Traditional Lipid Biomarkers.

Background: Lipid levels and markers of inflammation are commonly used to predict the risk of future cardiovascular events. However, the combined impact of these risk factors is still not fully explored. More research is needed to determine the long-term predictive value of these biomarkers in healthy individuals, as early-life interventions play a key role in reducing risk. Aim: To evaluate the additive effect of low grade inflammation and lipid profiles as predictors of ASCVD in a primary prevention cohort from UK Biobank. Methods: We analyzed baseline measurements of LDL-C, non-HDL-C, Estimated (E)-sdLDL-C, Estimated (E)-LDL-TG, ApoB, and C-reactive protein (CRP) from participants in the UK Biobank (n = 271,760), who were followed for up to 15 years. Individuals on lipid-lowering treatment or with incomplete follow-up records were excluded. The primary endpoint was major adverse cardiovascular event, which was a composite of myocardial infarction, CHD or stroke. We calculated hazard ratios (HR) and 95% confidence interval (CI) across quintiles of each biomarker, along its combination with all models adjusted for age, sex, race, diabetes, systolic blood pressure, smoking and hypertension medication. Results: The mean age at baseline was 56.3 years. The increasing quintiles of baseline levels of LDL-C, non-HDL-C, E-sdLDL-C, E-LDL-TG, ApoB, and CRP predicted ASCVD risk. Adjusted HR for the primary endpoint in comparison of the top with the bottom quintile were as follows LDL-C 1.39 (1.34-1.44), Non-HDL-C 1.52 (1.47-1.58), E-sdLDL-C 1.59 (1.53-1.65), E-LDL-TG 1.62 (1.58-1.63), ApoB 1.55(1.50-1.61) and CRP 1.58 (1.52-1.64). Each biomarker showed independent contributions to overall risk. Prediction models that incorporated markers of inflammation in addition to lipids were significantly better at predicting risk than models based on lipid levels alone. However, high particle number assessed by ApoB (>130 mg/dL) combined with CRP (>2 mg/L) conferred a higher risk for the primary endpoint (HR 1.69 [1.63-1.76]) than the rest of the components of the lipid panel. Conclusion: A single combined measure of ApoB with CRP was a better predictor of cardiovascular risk in healthy individuals beyond traditional lipid panel measurements in a 15-year follow-up. Earlier recognition of cardiovascular disease risk with these two markers in healthy individuals and proactive preventive efforts can be taken to mitigate risk.