Is hypertriglyceridemia a reliable indicator of cholesterol-depleted Apo B particles?

Objectives: Because cholesterol-depleted Apo B particles are thought to be a hallmark of hypertriglyceridemia, American, Canadian and European Lipid Guidelines suggest screening for Apo B only in patients with hypertriglyceridemia. Accordingly, this study examines the relationship of triglycerides to the LDL-C/Apo B and non-HDL-C/Apo B ratios.Methods: The study cohort consisted of 6272 NHANES subjects adjusted for a weighted sample size of 150 million subjects without previously diagnosed cardiac disease. Data was reported by LDL-C/Apo B tertiles as weighted frequencies and percent. Sensitivity, specificity, negative predictive and positive predictive values were calculated for triglycerides thresholds of > 150 mg/dL and > 200 mg/dL. The range of values of Apo B for decisional levels of LDL-C and non-HDL-C were also determined Results: Among patients with triglycerides > 200 mg/dL, 75.9% were amongst the lowest LDL-C/Apo B tertile. However, this represents only 7.5% of the total population. Of patients with the lowest LDL-C/Apo B ratio, 59.8% had triglycerides < 150 mg/dL. Moreover, there was an inverse relationship between non-HDL-C/Apo B such that elevated triglycerides were associated with the highest tertile of non-HDL-C/Apo B. Finally, the range of values of Apo B for decisional levels of LDL-C and non-HDL-C was determined and is so broad-30.3-40.6 mg/dl Apo B for different levels of LDL-C and 19.5 to 27.6 mg/dl Apo B for different levels of non-HDL-C-that neither is an adequate clinical surrogate for Apo B.Conclusion: Plasma triglycerides should not be used to restrict the measurement of Apo B since cholesterol-depleted Apo B particles may be present at any level of triglyceride.(c) 2023 National Lipid Association. Published by Elsevier Inc. All rights reserved.