Summary
Automated methods for the determination of apolipoprotein B and apolipoprotein A-I were developed, tested, and applied in screening programs of large populations to improve information about the composition and degree of hyperlipoproteinemia. Apolipoproteins B and A-I, total cholesterol, and triglyceride levels were measured in 25659 males and 18 144 females between 20 and 79 years of age, the majority subjectively healthy. The immunoturbidimetric methods used for apolipoproteins B and A-I were shown to be stable over time, and the errors of the methods were below 7%. Apolipoprotein B correlated with total cholesterol (r=0.86,P<0.001) for each age decile group and for both sexes (r=0.82–0.87,P<0.001). For a subsample comparable to the large population, apolipoprotein B correlated with cholesterol in low density (i.e., the atherogenic particle),r=0.89,P<0.001. The mean values for apolipoprotein B increased with age for both sexes, with much higher levels in males than in females under 50 years of age. Apolipoprotein A-I was lower in males than in females in all age-groups. At all cholesterol levels males had higher apolipoprotein B, and at the same triglyceride level, also lower apolipoprotein A-I and hence a higher B/A-I ratio than females. Using apolipoprotein B and A-I (high-density lipoprotein cholesterol) particles and adopting Swedish consensus criteria for the diagnosis of risk of iisk of ischemic heart disease, examples are given showing that many individuals, especially females, with high or borderline total serum cholesterol can be excluded from further investigation/treatment for hypercholesterolemia. In the age-group 40–49 years, a total cholesterol value of 6.5 mmol/l was found to correspond to an apolipoprotein B value of 1.39 g/l for males and to 1.32 g/l for females. Whereas 30% of males and 18% of females had total cholesterol values greater than or equal to 6.5 mmol/l, 19.7% of males and 7.5% of females had apolipoprotein B levels above 1.5 g/l (this cut-off point corresponds to a low-density lipoprotein cholesterol value of 5.0 mmol/l). It is suggested that the determination of apolipoprotein B and A-I levels be used to back up screening and facilitate the diagnosis of atherogenic and treatable high serum lipids.
Similar content being viewed by others
References
Albers JJ, Marcovina SM, Standardization of apolipoprotein B and A-I measurements. Clin Chem 35:1357, 1989
Albers JJ, Brunzell JD, Knopp RH, Apoprotein measurements and their clinical application. Clin Lab Med 9:137, 1989
Avogaro P, Bittolo Bon G, Cazzolato G, Quinci GB, Are apolipoproteins better discriminators than lipids for atherosclerosis? Lancet I: 901, 1979
Backer G de, Rosseneu M, Deslypere JP, Discriminative value of lipids and apolipoproteins in coronary heart disease. Atherosclerosis 42:197, 1982
Brunzell JD, Sniderman AD, Albers JJ, Kwiterovich PO Jr, Apolipoproteins B and A-I and coronary artery disease in humans. Arteriosclerosis 4: 79, 1984
Brustolin D, Maierna M, Aguzzi F, Zoppi F, Tarenghi G, Berti G, Immunoturbidimetric method for routine determinations of apolipoproteins A-I and B. Clin Chem 37:742, 1991
Cembrowski GS, Chandler EP, Westgard JO, Assessment of “average of normals” quality control procedures and guidelines for implementation. Am J Clin Pathol 81:492, 1984
Cooper GR, Henderson LO, Smith SJ, Hannon WH, Clinical applications and standardization of apolipoprotein measurements in the diagnostic workup of lipid disorders (editorial). Clin Chem 37:619, 1991
Dati F, Marcovina SM, Albers JJ, Die Standardisierung der Immunchemischen Bestimmungen von Apolipoprotein A-I und B. Behring Inst Mitt 86:116, 1990
Faergeman O, Action limits in hyperlipidemia. Scand J Clin Lab Invest 50 [Suppl 198]: 82, 1990
Gordon DJ, Rifkind BM, High-density lipoprotein-the clinical implications of recent studies. N Engl J Med 321:1311, 1989
Jacobs DR, et al., High density lipoprotein cholesterol as a predictor of cardiovascular disease mortality in men and women: the follow-up study of the Lipid Research Clinics Prevalence Study. Am J Epidemiol 131: 32, 1990
Labeur C, Shepherd J, Rosseneu M, Immunological assays of apolipoproteins in plasma: methods and instrumentation. Clin Chem 36: 591, 1990
Laboratory equipment—a challenge for UL ingenuity (by Hewitt LC, Underwriters Laboratories Inc, Chicago, USA). Labdata 16:4, 1985
Maciejko JJ, Levinson SS, Markyvech L, Smith MP, Blevins RD, New assay of apolipoproteins A-I and B by rate nephelometry evaluated. Clin Chem 33:2065, 1987
Marcovina SM, Albers JJ, Apolipoprotein assays: standardization and quality control. Scand J Clin Lab Invest 50 [Suppl 198]: 58, 1990
Marcovina S, Zoppo A, Graziani MS, Vassanelli C, Catapano AL, Evaluation of apolipoproteins A-I and B as markers of angiographically assessed coronary artery disease. La Ricerca Clin Lab 18:319, 1988
National Board of Health and Welfare, Drug Information Committee, Sweden, Treatment of hyperlipidemia. Uppsala: socialstyrelsens läkemedelsavdelning. Workshop 3, 1989
Olsson AG, Walldius G, Rössner S, Callmer E, Kaijser L, Studies on serum lipoproteins and lipid metabolism. Analysis of a random sample of 40 year old men. Acta Med Scand [Suppl] 637:1, 1980
Reinhart RA, Gani K, Arndt MR, Broste SK, Apolipoproteins A-I and B as predictors of angiographically defined coronary artery disease. Arch Intern Med 150:1629, 1990
Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Arch Intern Med 148:36, 1988
Riepponen P, Marniemi J, Rautaoja T, Immunoturbidimetric determination of apolipoproteins A-I and B in serum. Scand J Clin Lab Invest 47:739, 1987
Riesen WF, Mordasini R, Salzmann C, Theler A, Gurtner HP, Apolipoproteins and lipids as discriminators of severity of coronary heart disease. Atherosclerosis 37:157, 1980
Sandkamp M, Apolipoprotein-Diagnostik: klinische Relevanz. Diagn Lab 40: 37, 1990
Sniderman AD, Silberberg J, Is it time to measure apolipoprotein B (editorial)? Arteriosclerosis 10:665, 1990
Stein EA, Clinical significance and measurement of apolipoproteins A-I and B concentration. In: Rifai N, Warnick GR (eds) Methods for clinical laboratory measurement of lipid and lipoprotein risk factors. AACC Press, Washington, DC, USA. pp 17–31, 1991
Walldius G, Jungner I, Two limits of serum cholesterol levels are appropriate in diagnosis and treatment of hypercholesterolemia (in Swedish). Läkartidningen 85:3835, 1988
Walldius G, Jungner I, Steiner E, Hypertriglyceridemia—a common, often overlooked blood lipid disorder (in Swedish). Läkartidningen 86: 4227, 1989
Walldius G, Jungner I, Kolar W, Steiner E, Characterization of a high atherogenic risk population by apolipoprotein B determinations (abstract). J Intern Med 238 [Suppl 733]: 74, 1990
Walldius G, Jungner I, Kolar W, Steiner E, Apolipoprotein B and total serum cholesterol levels in 41 000 males and females (abstract). Clin Chem 36: 952, 1990
Walldius G, Jungner I, Kolar W, Steiner E, Apolipoprotein A-I and total serum cholesterol levels in 41 000 males and females (abstract). Clin Chem 36:952, 1990
Walmsley TA, Grant S, George PM, Effect of plasma triglyceride concentrations on the accuracy of immunoturbidimetric assays of apolipoprotein B. Clin Chem 37: 748, 1991
Warnick GR, Laboratory measurement of lipid and lipoprotein risk factors. Scand J Clin Lab Invest 50 [Suppl 198]: 9, 1990
Vega GL, Grundy SM, Does measurement of apolipoprotein B have a place in cholesterol management (editorial)? Arteriosclerosis 10: 668, 1990
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Jungner, I., Walldius, G., Holme, I. et al. Apolipoprotein B and A-I in relation to serum cholesterol and triglycerides in 43 000 Swedish males and females. Int J Clin Lab Res 21, 247–255 (1992). https://doi.org/10.1007/BF02591655
Issue Date:
DOI: https://doi.org/10.1007/BF02591655