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January 2, 2008

Utility of Different Lipid Measures to Predict Coronary Heart Disease

JAMA. 2008;299(1):35-36. doi:10.1001/jama.2007.4

To the Editor: Dr Ingelsson and colleagues1 conclude that their data do not support measurement of apo B or apo A-I in clinical practice when total cholesterol and HDL-C measurements are available. We believe their conclusions reach further than their data support.

First, the authors focus on the statistical significance of population-level models but apply their conclusions to the individual patient level. Second, the analysis was limited to low-risk, middle-aged white patients. By limiting their population to “healthy patients,” the authors specifically excluded patients with elevated triglyceride concentration—a population known to have higher apo B levels in the setting of normal traditional lipids.2 This omission could have skewed their data toward their conclusion. Third, the predictive value of the apo B:apo A-I ratio improves as a patient's risk (as measured by traditional risk markers) increases,3 and levels of HDL-C or apo A-I may not always represent the true protective or even the proatherogenic effects of these lipoproteins.4