"LDL-C has been the primary focus in lipid-lowering trials for more than two decades. A vast number of studies, both in primary and secondary prevention, have shown that there is a close relationship between LDL-C and CV event rates, the lower the LDL-C, the lower is the risk [163-165]. In several of these trials also apoB, apoA-I and the apo-ratio have been measured. When explaining the relationship of each lipid fraction and each apo-fraction to CV event reduction virtually all lipids as well as apoB and apoA-I and the apo-ratio are significantly related to outcome. However, LDL-C is much weaker predictor than apoB and any lipid ratio. The best relationship with CV risk reduction is the apo-ratio."
"...The apo-ratio, as shown in this paper, has commonly been shown to predict CV risk equally well or, in fact, more commonly even significantly better than conventional lipids in both prospective and treatment studies. So, which cut levels and targets of the apo-ratio should be recommended in the clinic to indicate CV risk before and after treatment? Since there is an almost linear increase (semi-log scale) in risk with increasing values of the apo-ratio from both AMORIS and the INTERHEART studies (Figure 10) it is clear that at values of the apo-ratio> 0.90(values should be given in two decimals in order not to lose important information) there is a considerable increase in risk, whereas values from 0.70 to about 0.90 are indicative of a moderate risk. Values for men < 0.70 and for fertile females < 0.60 can be more normal especially if no other risk factors are present.
The “ideal-biologically normal values” are rather < 0.50 as also documented in lipid-lowering trials in which CV events have been successfully reduced [176,177]. So the target values during therapy must focus on these levels, the lower the apo-ratio the better is the therapy."
Source: ibid (Same as above)
with all the new knowledge presented in this paper about the strong relations between apoB, apoA-I, and the apo-ratio, and CV risk as well as other disease manifestations, it is proposed, as many researchers have already done, that these strong risk predictors/factors/markers are included in new guidelines. In many disease conditions and manifestations of atherosclerosis apolipoproteins are at least equally informative, and often better than LDL-C, non-HDL-C and lipid ratios in predicting risk. It is realized that there will be pedagogical hurdles, but it should be possible to educate physicians, patients and health providers to understand that these apolipoproteins are markers of normal and abnormal cholesterol metabolism. The apo-ratio simply reflects the “balance between the bad cholesterols and the good cholesterols” technically measured by apolipoproteins.
The apo-ratio is a valid cardiovascular risk index (CRI) that reflects the level of CV risk for virtually all patients with different lipid phenotypes, the higher the value of the apo-ratio, the higher is the risk.
Finally, targeting lower values (about 0.50) of the apo-ratio during therapy may more correctly identify who is at risk or not at risk, and how high is the risk? Does the risk depend on the atherogenic apoB, or the anti-atherogenic apoA-I or rather on the most informative value i.e. the apo-ratio which summarizes the level of risk in a simple way?
Since physicians usually only manage to effectively evaluate and trust one laboratory marker, the apo-ratio is such a valid marker.
By simply plotting the value for a given patient on the risk line you can easily follow improvement during therapy and also motivate the patient to improve values to normal levels (Figure 10). New guidelines should at least contain equally objective information (cut-values and target values) on how to use apoB, apoA-I, and the apo-ratio as on lipids so that physicians can choose whichever diagnostic marker of risk they prefer.
Gradually this new apolipoprotein-based risk classification with a focus on the apoB/apoA-I ratio may, or rather should be, introduced in clinical practice."
As many of my followers know, in 2015, I had bypass surgery followed by 2 angioplasty procedures that resulted in the insertion of 4 stents, due to the failure of the bypass surgery.
Although I started on a regimen of pharmaceuticals for ongoing treatment following these procedures, I had bad side-effects from the statin drug - Crestor (Rosuvastatin). As a result I made major changes to my dietary habits and lifestyle so that I could address the cause of my CVD.
In October 2016, I took my last pharmaceutical medications and in the spring of 2019 I took my last baby aspirin. My blood biomarkers are all in the normal range with most in the 'optimal' range. My LDL-C is in the normal range at 2.99 mmol/l, which is higher than traditional secondary prevention standards would recommend, however, my ApoB/ApoA1 ratio is just 0.43 which is in the optimal range according to the conclusions reached by the study documented above. Furthermore, my LDL-P as measured through the NMR Lipoprofile test, is also in the optimal range at <1,000.
For these reasons, I resist suggestions from my cardiologist to restart statin therapy. I just had another echocardiogram a couple of weeks ago and it confirms that my heart is operating optimally with no evidence of damage.
I exercise daily including a regimen of 12,000 to 15,000 steps during the fall/winter and 15,000 to 25,000 steps during the spring summer. I go to the gym 5 days per week (year-round) and incorporate both HIIT Cardio (High Intensity Interval Training) as well as resistance training (weight lifting). I play ice hockey once or twice per week.
I follow the Mediterranean Diet with my core foods being:
- legumes, nuts, nut-butter, berries, apples, leafy green and cruciferous vegetables (broccoli, arugula, rapini, kale, dandelions, etc...); Limited consumption of animal protein - 3-4 days per week focused mostly on fish (salmon, trout, arctic char), and limited quantities of fermented dairy such as plain Greek yogurt, goat and sheep cheese, and aged cheeses such as Gouda. I limit alcohol to 3-4 glasses of red wine per week (no more than 5 oz per drink).
I am currently 57 years of age, male 5'10" with a 31" waist, and 155 lbs.