Apolipoprotein profiling may enhance CV risk assessment
Novel methods can greatly enhance the accuracy of lipoprotein profiling, thus improving cardiovascular (CV) risk prediction.
“Currently, we just monitor lipid classes, namely total cholesterol, triglycerides [TG], LDL-cholesterol [LDL-C] and HDL-cholesterol, focusing on quantity rather than molecular composition. Using mass spectrometry of plasma samples, we can identify proteins directly and more precisely,” said Professor Manuel Mayr of King's College London, UK. “The technique, called lipidomics, has shown that TG species containing saturated or monounsaturated fatty acids are associated with the highest CV risk.” [Circulation 2014;129:1821-1831; Am J Clin Nutr 2017;106;973-983]
Apolipoprotein profiling by mass spectrometry has demonstrated that apoB-100, apo C-I, apo C-II and apoL-I are positively associated with CV disease (CVD). Importantly, very low density lipoprotein (VLDL) carries not only apoB-100 (the main apolipoprotein on LDL-C), but also those other high-risk apolipoprotein species, suggesting a remaining high CV risk beyond LDL-C. [J Am Coll Cardiol 2017;69:789-900; J Am Coll Cardiol 2018;71;620-632]
“The strong association of certain TG species and VLDL-associated apolipoproteins with incident CVD supports the concept of targeting TG-rich lipoproteins to further reduce CVD risk in the statin era where LDL-C is already very low,” he suggested.
Proteomics studies have also identified several inflammation-related lipid species in atherosclerotic plaques. [J Clin Invest 2017;127:1546-1560] “Apolipoprotein constituents of LDL seem to be associated with inflammation and symptomatic plaques. This inflammatory signature seems to be driving the progression of atherosclerosis to manifest CVD, supporting the concept of targeting inflammation on top of lipid lowering,” noted Mayr.