Documento intersocietario sobre apolipoproteína B

Autores/as

  • Alberto Lorenzatti Federación Argentina de Cardiología
  • Stella M Macín Federación Argentina de Cardiología
  • Gabriela Portunato Federación Argentina de Sociedades de Endocrinología
  • Laura Schreier Sociedad Argentina de Lípidos
  • Melany Villareal-Galvez Federación Argentina de Sociedades de Endocrinología
  • Gabriela Berg Fundación Bioquímica Argentina
  • Carlos Cúneo Federación Argentina de Cardiología
  • Gerardo D Elikir Sociedad Argentina de Lípidos
  • Daniel Siniawski Sociedad Argentina de Cardiología
  • Augusto Lavalle-Cobo Sociedad Argentina de Cardiología
  • Melina Huerin Sociedad Argentina de Cardiología
  • Gustavo Giunta Sociedad Argentina de Cardiología
  • Santiago Lynch Sociedad Argentina de Cardiología
  • Walter Masson Sociedad Argentina de Lípidos
  • Juan P Nogueira Federación Argentina de Sociedades de Endocrinología
  • Viviana Arias Federación Argentina de Cardiología
  • Fátima Carreño Federación Argentina de Sociedades de Endocrinología
  • Pablo Coral Sociedad Argentina de Lípidos
  • Silvina Cuartas Sociedad Argentina de Lípidos
  • Sergio Giménez Federación Argentina de Cardiología
  • Mónica Virga Federación Argentina de Sociedades de Endocrinología

DOI:

https://doi.org/10.63600/ywv8hh96

Palabras clave:

Apolipoproteína B, Lipoproteínas aterogénicas, Lipoproteínas de baja densidad, Riego cardiovascular

Resumen

La apolipoproteína B (ApoB) es el principal componente proteico de las lipoproteínas aterogénicas, como las de muy baja densidad (VLDL), densidad intermedia (IDL) y baja densidad (LDL). Por lo tanto, la concentración plasmática de ApoB permite estimar el número total de partículas aterogénicas. En los últimos años, diversos estudios epidemiológicos y de intervención han demostrado que la medición de ApoB predice de forma independiente el riesgo cardiovascular, superando incluso a parámetros lipídicos convencionales como el colesterol unido a LDL (c-LDL), que sigue siendo la principal diana terapéutica en el tratamiento lipídico, con objetivos claramente definidos.

El objetivo de esta colaboración entre prestigiosas sociedades científicas es elaborar un documento de posicionamiento que aborde, de forma clara y práctica, diversos aspectos relacionados con la medición de ApoB, respondiendo a diez preguntas clave. Los mensajes principales se resumen en la figura central.

 

 

Biografía del autor/a

  • Alberto Lorenzatti, Federación Argentina de Cardiología

    Instituto médico DAMIC - Fundación Rusculleda

Referencias

1. Morze J, Melloni GEM, Wittenbecher C, Ala-Korpela M, Rynkiewicz A, et al. ApoB-containing lipoproteins: count, type, size, and risk of coronary artery disease. Eur Heart J. Apr 28:ehaf207, 2025.

2. Mehta A, Shapiro MD. Apolipoproteins in vascular biology and atherosclerotic disease. Nat Rev Cardiol. 19(3):168-179, 2022.

3. Dance GSC, Sowden MP, Cartegni L, Cooper E, Krainer AR, Smith HC. Two Proteins Essential for Apolipoprotein B mRNA Editing Are Expressed from a Single Gene through Alternative Splicing. J Biol Chem. 277(15):12703-12709, 2002.

4. Devaraj S, Semaan JR, Jialal I. Bioquímica, Apolipoproteína B. Disponible en: https://www-ncbi-nlm-nihgov.translate.goog/books/ NBK538139/?_x_tr_sl=en&_x_tr_tl=es&_x_tr_hl=es&_x_tr_pto=sge.

5. Haas ME, Attie AD, Biddinger SB. The regulation of ApoB metabolism by insulin. Trends Endocrinol Metab. 24(8):391-397, 2013.

6. Taghibiglou C, Carpentier A, Van Iderstine SC, Chen B, Rudy D, Aiton A, et al. Mechanisms of hepatic very low density lipoprotein overproduction in insulin resistance. Evidence for enhanced lipoprotein assembly, reduced intracellular ApoB degradation, and increased microsomal triglyceride transfer protein in a fructose-fed hamster model. J Biol Chem. 2000 Mar 24;275(12):8416-25.

7. Contois JH, Langlois MR, Cobbaert C, Sniderman AD. Standardization of Apolipoprotein B, LDL-Cholesterol, and Non-HDL-Cholesterol. J Am Heart Assoc. 12(15):e030405, 2023.

8. Warnick GR, Kimberly MM, Waymack PP, Leary ET, Myers GL. Standardization of measurements for cholesterol, triglycerides, and major lipoproteins. Lab Med. 39:48-90, 2008.

9. Garcia E, Bennett DW, Connelly MA, Jeyarajah EJ, Warf FC, Shalaurova I, et al. The extended lipid panel assay: a clinically deployed high-throughput nuclear magnetic resonance method for the simultaneous measurement of lipids and Apolipoprotein B. Lipids Health Dis. 19(1):247, 2020.

10. Langlois MR, Nordestgaard BG, Langsted A, Chapman MJ, Aakre KM, Baum H, et al. European Atherosclerosis Society (EAS) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Joint Consensus Initiative. Quantifying atherogenic lipoproteins for lipid-lowering strategies: consensus-based recommendations from EAS and EFLM. Clin Chem Lab Med. 58(4):496-517, 2020.

11. Johannesen CDL, Langsted A, Nordestgaard BG, Mortensen M. Excess Apolipoprotein B and Cardiovascular Risk in Women and Men. J Am Coll Cardiol. 83(23):2262-2273, 2024.

12. Sniderman AD, Williams K, Contois JH, Moroe HM, McQueen MJ, de Graaf J, et al. A meta-analysis of low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B as markers of cardiovascular risk. Circ Cardiovasc Qual Outcomes. 4(3):337-345, 2011.

13. Richardson TG, Sanderson E, Palmer TM, Ala-Korpela M, Ference BA, Davey Smith G, et al. Evaluating the relationship between circulating lipoprotein lipids and apolipoproteins with risk of coronary heart disease: A multivariable Mendelian randomisation analysis. PLoS Med. 17(3):e1003062, 2020.

14. Ference BA, Kastelein JJP, Ginsberg HN, Chapman MJ, Nicholls SJ, Ray KK, et al. Association of genetic variants related to CETP inhibitors and statins with lipoprotein levels and cardiovascular risk. JAMA. 318(10):947-956, 2017.

15. Gotto AM, Whitney E, Stein EA, Shapiro DR, Clearfield M, Weis S, et al. Relation between baseline and on-treatment lipid parameters and first acute major coronary events in the Air force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS). Circulation. 101:477-484, 2000.

16. Pedersen TR, Olsson AG, Faergeman O, Kjekshus J, Wedel H, Berg K, et al. Lipoprotein changes and reduction in the incidence of major coronary heart disease events in the Scandinavian Simvastatin Survival Study (4S). Circulation. 97:1453-60, 1998.

17. Thanassoulis G, Williams K, Ye K; Brook R, Couture P, Patrick R, Lawler PR, et al. Relations of Change in Plasma Levels of LDL-C, Non-HDL-C and apoB With Risk Reduction From Statin Therapy: A Meta-Analysis of Randomized Trials. J Am Heart Assoc. 3(2):e000759, 2014.

18. Cannon CP, Blazing MA, Giugliano RP, McCagg A, White JA., Theroux P, et al. Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med 372(25):2387–2397, 2015.

19. Sabatine MS, Giugliano RP, Keech AC, Honarpour N, Wiviott SD, Murphy SA, et al. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. N Engl J Med. 376:1713-1722, 2017.

20. Schwartz GG, Steg PG, Szarek M, Bhatt DL, Bittner VA, Diaz R, et al. Alirocumab after Acute Coronary Syndrome. N Engl J Med. 379(22):2097-2107, 2018.

21. Hopewell JC, Chen F, Wallendszus K, Stevens W, Collins R, Wiviott SD, et al. Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease. N Engl J Med. 377(13):1217-1227, 2017.

22. Bhatt D, Steg P., Miller M, Brinton EA, Jacobson T, Ketchum SB, et al. Reduction of Cardiovascular Events with Icosapent Ethyl for Hypertriglyceridemia. N Engl J Med. 380(1):11-22, 2019.

23. Nicholls SJ, Lincoff M, García M, Bash D, Ballantyne CM, Barter PJ, et al. Effect of High-Dose Omega-3 Fatty Acids vs Corn Oil on Major Adverse Cardiovascular Events in Patients at High Cardiovascular Risk: The STRENGTH Randomized Clinical Trial. JAMA 324(22):2268-2280, 2020.

24. Khan SU, Khan MU, Valavoor S, Khan MS, Okunrintemi V, Mamas MA, et al. Lipid-Lowering Therapies and Clinical Outcomes. Eur J Prev Cardiol. 27(12):1255-1268, 2020.

25. Ference BA, Cannon CP, Landmesser U, Lüscher TF, Catapano AL, Ray KK, et al. Reduction of LDL and Cardiovascular Outcomes. Eur Heart J. 39:2540-2545, 2018.

26. Liu J, Tang W, Chen G, Lu Y, Feng C, Tu XM. Correlation and agreement: overview and clarification of competing concepts and measures. Shanghai Arch Psychiatry. 28(2):115-120, 2016.

27. Pencina KM, Pencina MJ, Lawler PR, Engert JC, Dufresne L, Ridker PM, et al. Interplay of Atherogenic Particle Number and Particle Size and the Risk of Coronary Heart Disease. Clin Chem. 69(1):48-55, 2023

28. Cantey EP, Wilkins JT. Discordance between lipoprotein particle number and cholesterol content: an update. Curr Opin Endocrinol Diabetes Obes. 25(2):130–136, 2018.

29. Idris I, Tate H, Ahmad A, McCormack T. Concordance between plasma apolipoprotein B levels and cholesterol indices among patients receiving statins and nonstatin treatment: Post-hoc analyses from the U.K. InPractice study. J Clin Lipidol. 5(4):316-23, 2011.

30. Sniderman AD, Dufresne L, Pencina KM, Bilgic S, Thanassoulis G, Pencina MJ. Discordance among apoB, non-high-density lipoprotein cholesterol, and triglycerides: implications for cardiovascular prevention. Eur Heart J. 45(27):2410-2418, 2024.

31. Johannesen CDL, Mortensen MB, Børge Nordestgaard BG, Langsted A. Discordance analyses comparing LDL cholesterol, Non-HDL cholesterol, and apolipoprotein B for cardiovascular risk estimation. Atherosclerosis. 403:119139, 2025.

32. Wilkins JT, Li RC, Sniderman A, Chan C, DM Lloyd-Jones. Discordance between apolipoprotein B and LDL-cholesterol in young adults predicts coronary artery calcification: the CARDIA study. J Am Coll Cardiol. 67(2):193-201, 2016.

33. Glavinovic T, Thanassoulis G, de Graaf J, Couture P, Hegele RA, Sniderman AD. Physiological Bases for the Superiority of Apolipoprotein B Over Low-Density Lipoprotein Cholesterol and Non-High-Density Lipoprotein Cholesterol as a Marker of Cardiovascular Risk. J Am Heart Assoc. 11(20):e025858, 2022.

34. Nurmohamed NS, Ditmarsch M, Kastelein JJP. Cholesteryl ester transfer protein inhibitors: from high-density lipoprotein cholesterol to low-density lipoprotein cholesterol lowering agents? Cardiovasc Res. 118(14):2919-2931, 2022.

35. Griffin BA, Freeman DJ, Tait GW, Thomson J, Caslake MJ, Packard CJ, et al. Role of plasma triglyceride in the regulation of plasma low density lipoprotein (LDL) subfractions: relative contribution of small, dense LDL to coronary heart disease risk. Atherosclerosis. 106:241–253, 1994.

36. Sniderman AD, Islam S, Yusuf S, McQueen MJ. Discordance analysis of apolipoprotein B and non-high density lipoprotein choles-terol as markers of cardiovascular risk in the INTERHEART study. Atherosclerosis. 225(2):444–449, 2012.

37. Cromwell WC, Otvos JD, Keyes MJ, Pencina MJ, Sullivan L, Vasan RS, et al. LDL particle number and risk of future cardiovascular disease in the Framingham offspring study - implications for LDL management. J Clin Lipidol. 1(6):583-592, 2007.

38. Pencina MJ, D’Agostino RB, Zdrojewski T, Williams K, Thanassoulis G, Furberg CD, et al. Apolipoprotein B improves risk assessment of future coronary heart disease in the Framingham heart study beyond LDL-C and non-HDL-C. Eur J Prev Cardiol. 22(10):1321-1327, 2015.

39. Johannesen CDL, Langsted A, Mortensen MB, Nordestgaard BG. Apolipoprotein B and non-HDL cholesterol better reflect residual risk than LDL cholesterol in statin-treated patients in the Copenhagen General Population Study. Eur Heart J. 42(5):474-482, 2021.

40. Soffer D, Marston NA, Maki K, Jacobson T, Bittner V, Peña JM, et al. Role of apolipoprotein B in the clinical management of cardiovascular risk in adults: An Expert Clinical Consensus from the National Lipid Association. J Clin Lipidol.18(5):e647-e663, 2024.

41. Ahmad M, Sniderman AD, Hegele RA. Apolipoprotein B in cardiovascular risk assessment. CMAJ. 195:E1124, 2023.

42. Iavinovic T, Thanassoulis G, de Graaf J. Physiological bases for the superiority of apolipoprotein B over low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol as a marker of cardiovascular risk. J Am Heart Assoc. 11:e025858, 2022.

43. Cole J, Otvos DJ, Remaley TA. A Translational Tool to Facilitate Use of Apolipoprotein B for Clinical Decision-Making. Clinical Chemistry. 69(1):41-47, 2023.

44. Alpert J, Stone NJ. The Importance of Apo B and Lipoprotein Little a [Lp(a)]. Am J Med. 137(12):1149-1150, 2024.

45. Díaz JA, Castro-Cabezas M, Liemc A. Utilidad de la medición de la apolipoproteína B en la práctica clínica. Clin Invest Arterioscl. 17(3):142-146. 2005.

46. Pedro-Botet J, Climent E, Gabarró N, Millán J. Hiperlipemia familiar combinada/hiperlipemia mixta poligénica. Clin Invest Arterioscler. 33:43-49, 2021.

47. Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins Lancet. 366(9493):1267-1278. 2005.

48. Tremblay AJ, Lamarche B, Hogue JC, Couture P. Effects of ezetimibe and simvastatin on apolipoprotein B metabolism in males with mixed hyperlipidemia. J Lipid Res. 50(7):1463-1471, 2009.

49. Ray KK, Wright RS, Kallend D, Koenig W, Leiter LA, Raal FJ. Two Phase 3 Trials of Inclisiran in Patients with Elevated LDL Cholesterol. N Engl J Med. 382(16):1507-1519, 2020.

50. Goldberg AC, Leiter LA, Stroes ESG, Baum SJ, Hanselman JC, Bloedon LT, et al. Effect of Bempedoic Acid vs Placebo Added to Maximally Tolerated Statins on Low-Density Lipoprotein Cholesterol in Patients at High Risk for Cardiovascular Disease: The CLEAR Wisdom Randomized Clinical Trial. JAMA. 322(18):1780-1788, 2019.

51. Koseki M, Stroes E, Ali S, Banerjee P, Chan KC, Khilla N, et al. The Long-Term Efficacy and Safety of Evinacumab in Patients With Homozygous Familial Hypercholesterolemia. JACC Adv. 2(9):100648, 2023.

52. Cuchel M, Meagher EA, du Toit Theron H, Blom DJ, Marais AD, Hegele RA, et al. Efficacy and safety of a microsomal triglyceride transfer protein inhibitor in patients with homozygous familial hypercholesterolaemia: a single-arm, open-label, phase 3 study. N Engl J Med. 368(2):1277-1287. 2013.

53. Masson W, Barbagelata L, Lobo M, Nogueira JP, Handelsman Y. Lipid-lowering efficacy of obicetrapib: A comprehensive systematic review and meta-analysis. J Clin Lipidol. Dec 30:S1933-2874(24)00301-5, 2024.

54. Contois JH, McConnell JP, Sethi AA, Csako G, Devaraj S, Hoefner DM, et al. Apolipoprotein B and cardiovascular disease risk: position statement from the AACC Lipoproteins and Vascular Diseases Division Working Group on Best Practices. Clin Chem. 53(3):407-419, 2009.

55. Anderson TJ, Grégoire J, Hegele RA, Couture P, Mancini GBJ, McPherson R, et al. 2012 Update of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult. Can J Cardiol. 29:151-167, 2013.

56. Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, et al. 2016 ESC/EAS guidelines for the management of dyslipidaemias. Eur Heart J. 37:2999-3058, 2016.

57. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association task forcé on clinical practice guidelines. Circulation. 139:e1082–e1143, 2019.

58. Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: the task force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). Eur Heart J. 2019;41:111-188, 2019.

59. Handelsman Y, Jellinger PS, Guerin CK, Bloomgarden ZT, Brinton EA, Budoff MJ, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the management of dyslipidemia and prevention of cardiovascular disease algorithm: 2020 executive summary. Endocr Pract. 26:1196-1224, 2020.

60. Pearson GJ, Thanassoulis G, Anderson TJ, Barry AR, Couture P, Dayan N, et al. 2021 Canadian Cardiovascular Society guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in adults. Can J Cardiol. 37:1129-1150, 2021.

61. Siniawski D, Masson W, Bluro I, Sorroche P, Scordo W, Krauss J, et al. Niveles plasmáticos de apolipoproteínas en una población saludable de la Argentina: implicaciones en prevención cardiovascular. Rev Argent Cardiol. 78:123-128, 2010.

62. Wakabayashi T, Takahashi M, Okazaki H, Okazaki S, Yokote K, Tada H, et al. Current Diagnosis and Management of Familial Hypobetalipoproteinemia. J Atheroscler Thromb. 31(7):1005-1023, 2024.

63. Buryska S, Ahn JC, Allen, AM, Simha V, Simonetto DA. Familial Hypobetalipoproteinemia: An Under Recognized Cause of Lean NASH. Hepatology. 74(5):2897-2898, 2021.

64. Rimbert A, Vanhoye X, Coulibaly D, Marrec M, Pichelin M, Charrière S, et al. Phenotypic Differences Between Polygenic and Monogenic Hypobetalipoproteinemia. Arterioscler Thromb Vasc Biol. 41(1): e63–e71, 2021.

65. Handhle A, Viljoen A, Ramachandran R, Wierzbicki AS. Low cholesterol Syndrome and drug development. Curr Opin Cardiol. 35(4):423-427, 2020.

Publicado

22-12-2025

Cómo citar

1.
Documento intersocietario sobre apolipoproteína B. Rev. Fed. Arg. Cardiol. [Internet]. 22 de diciembre de 2025 [citado 26 de septiembre de 2026];54(4):266-7. Disponible en: https://revistafac.org.ar/ojs/index.php/revistafac/article/view/745