ApoB Levels Reveal Notable Heterogeneity by Hispanic, Latino Background

Leandro Slipczuk, MD, PhD

Credit: LinkedIn

Apolipoprotein B (apoB) levels exhibited significant heterogeneity by self-identified Hispanic or Latino background, genetic ancestry, and atherosclerotic cardiovascular disease (ASCVD) risk cohorts, according to new analysis of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).¹

Examination of the more than 16,000 participants with a diverse background in HCHS/SOL revealed an elevated (>130 mg/dL) apoB concentration present in nearly one-quarter with intermediate or high ASCVD risk, providing clinical implications for its use in ASCVD risk assessment.

“In this cohort study representing a diverse, population-representative sample of US Hispanic or Latino individuals, it was found that apoB levels varied significantly according to demographic and socioeconomic factors, acculturation, and genetic ancestral components,” wrote the investigative team, led by Leandro Slipczuk, MD, PhD, division of cardiology in the department of medicine at Montefiore Medical Center, Albert Einstein Medical College.

Individuals in the US with Hispanic or Latino backgrounds are at an elevated risk of mortality from ASCVD, driven by the deposition of apoB-containing lipoprotein particles within the arterial wall.² Recent guidelines in the US and beyond have favored the notability of apoB as an ASCVD risk factor, particularly over low-density lipoprotein cholesterol (LDL-C) or non-high-density lipoprotein cholesterol (non-HDL-C).³

Nonetheless, Slipczuk and colleagues pointed to a dearth of evidence on Hispanic or Latino individuals, with most data on apoB centered around non-Hispanic White populations from the US and Europe.¹ Collecting data from the HCHS/SOL cohort (n = 16,415), the team measured the distribution of apoB and its association with baseline sociodemographic and clinical variables.

Participants in HCHS/SOL were recruited from four US metropolitan areas: New York, Chicago, Miami, and San Diego. The study population had an average age of 41 years, most (51.9%) were female, and the mean apoB level was 99.8 mg/dL. Notably, mean apoB levels were significantly higher in male versus female participants (102.4 vs. 97.4 mg/dL, respectively) and older age groups.

Slipczuk and colleagues found the baseline prevalence of hypertension, diabetes, elevated body mass index (BMI), and ASCVD risk category were significantly increased with higher apoB levels, irrespective of statin use. Approximately 26.5% of participants with a 10-year ASCVD risk greater than or equal to 7.5% experienced elevated apoB concentrations (>130 mg/dL).

Further analysis revealed significant heterogeneity in mean apoB levels across self-identified Hispanic or Latino background groups. According to the report, these rates ranged from 95.1 mg/dL in individuals of Dominican descent to 104.8 mg/dL in individuals of Cuban descent.

Specifically, across higher apoB tertiles, median West African genetic ancestry was lower, while median Amerindian genetic ancestry was higher. Approximately 14.7% of Hispanic/Individuals experienced discordant apoB and LDL-C values, with only 7.7% reporting discordant and non-HDL-C values, irrespective of statin use.

Although they noted that apoB is not yet used as a standard clinical measure, Slipczuk and colleagues indicated the need for further research to examine and determine the prognostic significance of using apoB with risk assessment, particularly ASCVD.

The fact that apoB was high in a significant proportion of participants regardless of the ASCVD category and LDL-C concentrations suggests that apoB could be an important prognostic marker of ASCVD risk and that apoB could complement risk assessment with tools, such as the pooled cohort equations when used among Hispanic individuals,” they added.

References

1. _{Slipczuk L, Kuno T, Marcovina S, et al. Heterogeneity of Apolipoprotein B Levels Among Hispanic or Latino Individuals Residing in the US. JAMA Cardiol. Published online January 02, 2025. doi:10.1001/jamacardio.2024.4789}
2. _{Sniderman AD, Navar AM, Thanassoulis G. Apolipoprotein B vs Low-Density Lipoprotein Cholesterol and Non-High-Density Lipoprotein Cholesterol as the Primary Measure of Apolipoprotein B Lipoprotein-Related Risk: The Debate Is Over. JAMA Cardiol. 2022;7(3):257-258. doi:10.1001/jamacardio.2021.5080
   Grundy SM, Stone NJ, Bailey AL, et al. 2018}
3. _{AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Circulation. 2019 Jun 18;139(25):e1182-e1186. doi: 10.1161/CIR.0000000000000698] [published correction appears in Circulation. 2023 Aug 15;148(7):e5. doi: 10.1161/CIR.0000000000001172]. Circulation. 2019;139(25):e1082-e1143. doi:10.1161/CIR.0000000000000625}