Research Papers:

The “bad” cholesterol can predict abnormal apolipoprotein B levels in a large unselected outpatient cohort

Guo-Ming Zhang _, Hemant Goyal, Gao-Ming Zhang, Xiao-Bo Ma and Ye-Ting Zhou

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Oncotarget. 2018; 9:8011-8015. https://doi.org/10.18632/oncotarget.23759

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Guo-Ming Zhang1,*, Hemant Goyal2,*, Gao-Ming Zhang1, Xiao-Bo Ma1 and Ye-Ting Zhou1

1Shuyang People’s Hospital, Affiliated Shuyang Hospital, Xuzhou Medical University, Shuyang 223600, China

2Department of Internal Medicine, Mercer University School of Medicine, Macon 31201, GA, USA

*These author is co-first authors, and contributed equally to this work

Correspondence to:

Guo-Ming Zhang, email: [email protected]

Keywords: total cholesterol; high-density lipoprotein cholesterol; low-density lipoprotein cholesterol; apolipoprotein B; reflex test

Received: August 30, 2017     Accepted: December 23, 2017     Published: December 29, 2017


Background: The significant association between total cholesterol (TC), non-high-density lipoprotein cholesterol (non-HDL), and low-density lipoprotein cholesterol (LDL) has been shown to be associated with Apolipoprotein B (Apo B). The objective of this study was to assess whether abnormal levels of TC, non-HDL and LDL can be used as predictors of abnormal serum Apo B levels.

Results: TC (r = 0.752), non-HDL (r = 0.799), and LDL(r = 0.817) were significantly positively correlated with Apo B. Areas under the curve of TC, non-HDL, and LDL for predicting abnormal Apo B (>1.10 g/L) were 0.906, 0.918, and 0.928, respectively. The optimal thresholds of prediction of abnormal Apo B were 5.13 mmol/L for TC, 4.23 mmol/L for non-HDL, and 3.34 mmol/L for LDL. At these optimal thresholds of TC, non-HDL and LDL, less than 1.13%, 1.67%, and 0.62% of tests with abnormal Apo B results would have been missed, but approximately 69.4%, 79.7%, and 73.2% of the performed Apo B tests could have been eliminated, respectively.

Conclusions: Apo B levels of unselected outpatients need be not tested (especially when LDL < 3.34 mmol/L, non-HDL < 4.23 mmol/L, and/or TC < 5.13 mmol/L). It will result in 69% reduction in number of ordered Apo B tests. LDL was significantly better than the TC and non-HDL for predicting abnormal Apo B indicating that Apo B needn’t tested when LDL level is normal.

Methods: We retrospectively analyzed results of TC, HDL, LDL, and Apo B in a large cohort of unselected outpatients (n = 5486) in Shuyang People’s Hospital, Shuyang, China. Non-HDL was calculated by deducting HDL from TC. Correlations between TC, non-HDL, LDL, and Apo B were analyzed by using Spearman’s rho approach. Receiver operating characteristics curve analysis was used to evaluate the predictive value of TC, non-HDL, and LDL for abnormal Apo B.

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