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Risk Factors for Cardiovascular Disease in Women
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To the Editor: Dr Ridker and colleagues1 report that, in a large subgroup of participants in the Women's Health Study, apolipoproteins B and A-I offer no advantage over non–high-density lipoprotein (HDL) cholesterol and the ratio of total cholesterol to HDL cholesterol in the prediction of future cardiovascular events. However, the generalizability of their conclusions is threatened by their use of a low-risk population and by the difference between the predictive accuracy of variables within a total group and the predictive accuracy of variables within distinct subgroups.
Low-density lipoprotein (LDL) is heterogeneous in composition. Many individuals have predominantly large buoyant cholesterol-rich LDL particles while other individuals have predominantly small dense cholesterol-poor LDL particles.2 Whenever small dense LDL particles are the predominant subspecies, the cholesterol indices will underestimate the atherogenic particle number, which is what apolipoprotein B measures.
Apolipoprotein B is superior to cholesterol indices only when elevated numbers of small dense . . . [Full Text of this Article]
Allan D. Sniderman, MD
Allan.Sniderman@muhc.mcgill.ca
Mike Rosenbloom Laboratory for Cardiovascular Research
Royal Victoria Hospital
Montreal, Quebec
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