Are elevated apolipoprotein B (apoB) and/or non-high-density lipoprotein (non-HDL) cholesterol superior to elevated low-density lipoprotein (LDL) cholesterol in identifying statin-treated patients at residual risk of all-cause mortality and myocardial infarction?
ApoB Home Test Kit (J Am Coll Cardiol 2021, PMID 33736827) — discordant high apoB with low LDL cholesterol yielded hazard ratios of 1.21 for all-cause mortality and 1.49 for myocardial infarction. The abstract for ApoB Home Test Kit states no limitations.
Source: J Am Coll Cardiol 2021, PMID 33736827 ↗ · Research map · How Magellan grades evidence · evidence confidence: medium
J Am Coll Cardiol · 2021 · PMID 33736827 · DOI 10.1016/j.jacc.2021.01.027
ApoB and non-HDL cholesterol are better indicators of residual risk for death and heart attack in statin-treated patients than LDL cholesterol.
The question
Are elevated apolipoprotein B (apoB) and/or non-high-density lipoprotein (non-HDL) cholesterol superior to elevated low-density lipoprotein (LDL) cholesterol in identifying statin-treated patients at residual risk of all-cause mortality and myocardial infarction?
What they tested
The study sought to determine if elevated apoB and/or non-HDL cholesterol are superior to elevated LDL cholesterol in identifying statin-treated patients at residual risk of all-cause mortality and myocardial infarction.
How they did it
The study included 13,015 statin-treated patients from the Copenhagen General Population Study with a median follow-up of 8 years. Cox regressions were used to examine associations between apoB, non-HDL cholesterol, and LDL cholesterol with all-cause mortality or myocardial infarction, both on continuous scales and by categories of concordant and discordant values defined by medians.
What they found
High apoB and non-HDL cholesterol were associated with increased risk of all-cause mortality and myocardial infarction, while high LDL cholesterol showed no such associations. Discordant high apoB with low LDL cholesterol yielded hazard ratios of 1.21 for all-cause mortality and 1.49 for myocardial infarction. Discordant high non-HDL cholesterol with low LDL cholesterol yielded hazard ratios of 1.18 for all-cause mortality and 1.78 for myocardial infarction. Discordant high apoB with low non-HDL cholesterol yielded a hazard ratio of 1.21 for all-cause mortality and 0.93 for myocardial infarction. Dual discordant high apoB and non-HDL cholesterol with low LDL cholesterol showed hazard ratios of 1.23 for all-cause mortality and 1.82 for myocardial infarction.
| High ApoB, Low LDL (Mortality) | 1.21 | |
|---|---|---|
| High ApoB, Low LDL (MI) | 1.49 | |
| High Non-HDL, Low LDL (Mortality) | 1.18 | |
| High Non-HDL, Low LDL (MI) | 1.78 | |
| High ApoB, Low Non-HDL (Mortality) | 1.21 | |
| High ApoB, Low Non-HDL (MI) | 0.93 | |
| High ApoB & Non-HDL, Low LDL (Mortality) | 1.23 | |
| High ApoB & Non-HDL, Low LDL (MI) | 1.82 |
Hazard ratios for all-cause mortality and myocardial infarction based on different discordant lipid profiles in statin-treated patients.
What it means
In statin-treated patients, elevated apoB and non-HDL cholesterol, but not LDL cholesterol, are associated with residual risk of all-cause mortality and myocardial infarction. ApoB is a more accurate marker of all-cause mortality risk than LDL cholesterol or non-HDL cholesterol, and a more accurate marker of myocardial infarction risk than LDL cholesterol.
Limitations
The abstract does not explicitly state any limitations of the study.
Where the published abstract does not list limitations, we say so rather than inventing them. Read the full paper on PubMed before drawing conclusions.
The paper at a glance
| Magellan’s evidence label | Apolipoprotein B particle count (our label for this citation — see PubMed for the paper’s own title and authors) |
|---|---|
| Journal | J Am Coll Cardiol |
| Year | 2021 |
| PMID | 33736827 ↗ |
| DOI | 10.1016/j.jacc.2021.01.027 ↗ |
| Topic | Cardiovascular & vascular aging |
Read the source: PubMed record (authors, abstract, full citation) ↗ · Publisher via doi.org ↗
Where Magellan uses this paper
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ApoB Home Test Kit
Large Mendelian randomization studies, prospective cohorts and meta-analyses — in one pooling of 233,455 people apoB was the strongest lipid risk marker, about 12% better than LDL-cholesterol — indicate that apoB is the predominant lipid trait driving atherosclerotic cardiovascular disease, and that the particle…
Apolipoprotein B (apoB) is the primary structural protein of the atherogenic lipoproteins, with exactly…
Research describes the compound or intervention studied. It is not a claim about any specific product.
Molecules & mechanisms in this paper
Each of these is named in the paper’s own words above. Open the monograph for the full mechanism and its other citations.
Cite this page
These citations point at this summary. To cite the original paper with its full author list, use the PubMed record or doi.org.
Magellan Longevity. (2026). Are elevated apolipoprotein B (apoB) and/or non-high-density lipoprotein (non-HDL) cholesterol superior to elevated low-density lipoprotein (LDL) cholesterol in identifying statin-treated patients at residual risk of all-cause mortality and myocardial infarction? [Plain-English summary of J Am Coll Cardiol 2021, PMID 33736827, DOI 10.1016/j.jacc.2021.01.027]. Magellan Longevity. https://magellanlongevity.com/study/s140.html@misc{magellan_s140,
title = {Are elevated apolipoprotein B (apoB) and/or non-high-density lipoprotein (non-HDL) cholesterol superior to elevated low-density lipoprotein (LDL) cholesterol in identifying statin-treated patients at residual risk of all-cause mortality and myocardial infarction?},
author = {{Magellan Longevity}},
year = {2026},
howpublished = {\url{https://magellanlongevity.com/study/s140.html}},
note = {Plain-English summary of PubMed PMID 33736827; DOI 10.1016/j.jacc.2021.01.027; J Am Coll Cardiol 2021. Reviewed by Gabriel Radu, DO},
urldate = {2026-08-11}
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