Serum Apolipoprotein B Levels and Apolipoprotein B/Apolipoprotein A1 Ratio as Predictors of Dyslipidemia Risk in Patients Treated with Second-Generation Antipsychotics: A Retrospective Cohort Study

Jia-Xuan Zhang,1 Zhi-Qiang Huang,1 Jian-Ming Yang,2 Wen-Yong Wang,3 Wei-Na Li2 1Clinical Lab, Zhongshan Third People’s Hospital, Zhongshan, Guangdong, People’s Republic of China; 2Nanlang Outpatient Department, Zhongshan Third People’s Hospital, Zhongshan, Guangdong, People’s Republic of China; 3Department of Geriatric Mental Disorders, Zhongshan Third People’s Hospital, Zhongshan, Guangdong, People’s Republic of ChinaCorrespondence: Wei-Na Li, Nanlang Outpatient Department, Zhongshan Third People’s Hospital, 80 Tianbian Main Street, Nanlang Subdistrict, Zhongshan, Guangdong, 528451, People’s Republic of China, Email [email protected]: To assess the predictive ability of baseline serum apolipoprotein B (ApoB) and the ratio of ApoB to apolipoprotein A1 (ApoB/ApoA1 ratio) for dyslipidemia risk in patients receiving second-generation antipsychotics (SGAs).Patients and Methods: Medical records of patients hospitalized between March 2019 and March 2025 were retrospectively reviewed. The optimal cut-off points for baseline serum ApoB levels and the ApoB/ApoA1 ratio were identified using a maximally selected log-rank statistic analysis. Multivariable Cox proportional hazards models estimated hazard ratios (HRs) with 95% confidence intervals (95% CIs). The Kaplan-Meier method with Log rank testing was used to compare the cumulative incidence of dyslipidemia between groups defined by these cut-off points.Results: Of 311 enrolled patients, 33 (10.6%) lacking baseline ApoA1 measurements were excluded from ApoB/ApoA1 ratio analyses. The optimal cut-off points were 0.70 g/L for baseline ApoB and 0.45 for the ApoB/ApoA1 ratio. Multivariable Cox proportional hazards models, fully adjusted for covariates, demonstrated significantly elevated dyslipidemia risk for patients exceeding these thresholds vs low-risk groups: adjusted HR 2.98 (95% CI: 2.05– 4.32, p < 0.001) for high ApoB and 3.17 (95% CI: 1.62– 6.22, p = 0.001) for high ApoB/ApoA1 ratio. Continuous analysis showed each 0.1 g/L ApoB increase conferred a 34% higher risk (adjusted HR 1.34, 95% CI: 1.21– 1.48, p < 0.001), while each 0.1-unit ApoB/ApoA1 ratio increase conferred a 20% higher risk (adjusted HR 1.20, 95% CI: 1.10– 1.30, p < 0.001). Kaplan-Meier curves confirmed significantly higher cumulative dyslipidemia incidence in high vs low groups for both markers (Log rank test, both p < 0.001).Conclusion: Baseline serum ApoB levels and the ApoB/ApoA1 ratio are valuable risk markers for dyslipidemia in patients treated with SGAs.Keywords: ApoB, ApoB/ApoA1, metabolic risk, second-generation antipsychotics, biomarker, maximally selected log-rank