Discordantly high apolipoprotein B despite normal LDL cholesterol across AHA PREVENT cardiometabolic risk strata among U.S. adults.

Authors

Miao Bai, Tongyuge Yan

Published in

Journal of diabetes and metabolic disorders. Volume 25. Issue 2. Pages 269. Epub Sep 25, 2026.

Abstract

Apolipoprotein B (ApoB) reflects the number of circulating atherogenic lipoprotein particles and may reveal residual lipid-related risk when LDL cholesterol (LDL-C) appears normal. Whether AHA PREVENT-estimated cardiovascular risk identifies LDL-C-normal adults with discordantly high ApoB remains unclear.
We analyzed NHANES 2005-2016 adults aged 30-79 years without prevalent cardiovascular disease. Discordantly high ApoB was defined as LDL-C < 100 mg/dL with ApoB ≥ 90 mg/dL. Survey-weighted analyses estimated ApoB-high prevalence across AHA PREVENT-estimated ASCVD, total CVD, and heart failure risk domains. Additional analyses examined alternative PREVENT thresholds, percentile-based ApoB-LDL-C discordance, discrimination using weighted AUC, and attenuation after accounting for shared cardiometabolic determinants.
Among 7659 adults in the final analytic sample, 2122 had LDL-C < 100 mg/dL. Within this LDL-C-normal subgroup, elevated PREVENT-estimated ASCVD risk was associated with higher ApoB-high prevalence than low risk (18.1% vs. 8.6%; crude OR 2.36, 95% CI 1.66-3.37). Similar patterns were observed for total CVD risk (16.6% vs. 7.7%; OR 2.39, 95% CI 1.67-3.41) and heart failure risk (15.8% vs. 9.1%; OR 1.87, 95% CI 1.24-2.81). Results were directionally consistent using alternative PREVENT thresholds and percentile-based ApoB-LDL-C discordance definitions. However, discrimination for ApoB ≥ 90 mg/dL was stronger for lipid-specific markers such as non-HDL-C and triglycerides than for PREVENT risk alone, and the PREVENT-ApoB association was substantially attenuated after adjustment for triglycerides and other shared metabolic determinants.
Elevated PREVENT-estimated risk identifies LDL-C-normal adults with higher prevalence of discordantly high ApoB, but this pattern largely reflects shared cardiometabolic determinants rather than independent prediction. PREVENT-based risk stratification may help identify higher-yield groups for ApoB assessment, while prospective outcome studies are needed to determine its clinical utility.
The online version contains supplementary material available at https://doi.org/10.1007/s40200-026-02091-3.

PMID:
42801018
Bibliographic data and abstract were imported from PubMed on 27 Sep 2026.

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