ApoB statt LDL: der bessere Risikomarker

Atherosclerotic cardiovascular disease (ASCVD) remains the leading global cause of morbidity and mortality, even in the era of aggressive low-density lipoprotein cholesterol (LDL-C) lowering. This persistent residual risk has prompted a reevaluation of atherogenic lipid markers, with non-high-density lipoprotein cholesterol (non-HDL-C) and apolipoprotein B (Apo B) emerging as superior indicators of the total atherogenic particle burden. Unlike LDL-C, non-HDL-C includes cholesterol from all atherogenic lipoproteins, while Apo B reflects the total number of atherogenic particles regardless of cholesterol content. Their clinical relevance is underscored in populations with diabetes, obesity, and hypertriglyceridemia, where LDL-C may not adequately reflect cardiovascular risk. This review explores the biological, clinical, and genetic foundations of non-HDL-C and Apo B as critical tools for risk stratification and therapeutic targeting. It highlights discordance analysis, inflammatory mechanisms in atherogenesis, the influence of metabolic syndromes, and their utility in specific populations, including those with chronic kidney disease and children with familial hypercholesterolemia. Additionally, the role of lipoprotein (a), glycation in diabetes, and hypertriglyceridemia are examined as contributors to residual risk. Clinical trials and genetic studies support Apo B and non-HDL-C as more robust predictors of cardiovascular events than LDL-C. Current guidelines increasingly endo

<h4>Background</h4>The association between low-density lipoprotein (LDL) cholesterol and increased mortality risk has been well-documented, yet apolipoprotein B (apoB) is regarded as a more precise risk indicator. However, a comprehensive analysis integrating both markers in relation to mortality risk remains unreported.<h4>Objectives</h4>This study aimed to investigate the relationship between LDL cholesterol levels and mortality across varying apoB concentrations within the general population.<h4>Methods</h4>Data from 15,380 participants in the 2005-2016 National Health and Nutrition Examination Survey (NHANES) were utilized to construct Cox regression models and apply restricted cubic splines, assessing the association between LDL cholesterol and mortality across distinct apoB stratifications.<h4>Results</h4>The study cohort had a median (IQR) age of 46.0 (32.0, 60.0) years, with 7949 (51.8%) males. During a median follow-up of 101.0 months (IQR: 67-137), 1771 (8.8%) all-cause mortality events were observed; 443 (2.1%) deaths were attributed to cardiovascular diseases, while 109 (0.5%) resulted from cerebrovascular diseases. Low apoB and LDL-cholesterol levels were independently linked to an elevated risk of all-cause and cardiovascular mortality. Compared with participants having apoB <90 mg/dL and LDL-cholesterol levels between 100-129 mg/dL, those with LDL-cholesterol <70 mg/dL (HR, 1.81; 95%CI: 1.39-2.36) and 70-99 mg/dL (HR, 1.28; 95%CI: 1.01-1.62) demonstrated a high

<b>Background</b>: Physical activity (PA) is associated with cardiometabolic health and functional performance, but evidence from real-world primary care populations simultaneously examining PA, low-density lipoprotein cholesterol (LDL-C), and functional performance remains limited. <b>Objective</b>: This study evaluated associations between PA, LDL-C, and functional performance in a real-world primary care cohort. <b>Methods</b>: This cross-sectional observational study included 863 adult primary care patients evaluated between February 2021 and March 2026. The overall cohort had a mean age of 52.4 ± 14.8 years, and 53.3% of participants were female. PA was assessed using self-reported activity categories (low, moderate, or high) obtained during a routine clinical evaluation. LDL-C concentrations were analyzed in the full cohort, while Timed Up and Go (TUG) functional performance assessment was available in an exploratory subgroup (<i>n</i> = 214). Multivariable regression analyses were adjusted for age, sex, body mass index (BMI), diabetes mellitus, and arterial hypertension in the TUG analysis. <b>Results:</b> Higher PA categories were associated with lower LDL-C concentrations across groups (<i>p</i> < 0.001). Mean LDL-C concentrations were 3.68 ± 1.05 mmol/L in the low PA group, 3.39 ± 0.97 mmol/L in the moderate PA group, and 3.12 ± 0.89 mmol/L in the high PA group. In the exploratory TUG subgroup, higher PA categories were also associated with better functional perform