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To the Editor: In their study of the clinical utility of lipid measures for prediction of coronary heart disease (CHD), Dr Ingelsson and colleagues¹ suggest that the measurement of apolipoprotein B (apo B) or apolipoprotein A-I (apo A-I) and its ratio should not be used in clinical practice. This conclusion was supported by the finding that the Apo B:Apo A-I ratio did not provide additional information over the total cholesterol:high-density lipoprotein cholesterol (HDL-C) ratio for the prediction of CHD in a population-based prospective cohort study of 3322 men and women from Framingham, Massachusetts. We believe that this conclusion is not adequately supported by their data for a number of reasons.

First, the total number of outcome events was relatively small (291); after sex-stratified analysis, only 93 events occurred in women, who comprised 53% of the study population. Second, the "composite end point" definition mixed a diverse group of cardiovascular events . . . [Full Text of this Article]

Justo Sierra-Johnson, MD, MSc
jusier@ki.se
Atherosclerosis Research Unit
Department of Medicine
Karolinska Institutet
Stockholm, Sweden

Abel Romero-Corral, MD, MSc; Francisco Lopez-Jimenez, MD, MSc
Department of Internal Medicine
Division of Cardiovascular Diseases
Mayo Clinic and Foundation
Rochester, Minnesota

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