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ApoB

ApoB. ApoB is found on LDL, IDL and VLDL In healthy patients, 95% of ApoB appears on LDL ApoB appears on the outer shell of LDL and unlocks specific receptors to deliver cholesterol to cells throughout the body. ApoB Test measures the number of ApoB- 100 particles

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ApoB

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  1. ApoB • ApoB is found on LDL, IDL and VLDL • In healthy patients, 95% of ApoB appears on LDL • ApoB appears on the outer shell of LDL and unlocks specific receptors to deliver cholesterol to cells throughout the body. • ApoB Test measures the number of ApoB-100 particles Is a general measure of particle concentration

  2. Gradient driven process…LDL Particles invade the arterial wall The higher the number of LDL particles (LDL-P), the greater the risk for CHD. • Oxidative Modification • Foam Cell Formation • Atherosclerosis It’s about the number of particles! (LDL-P) 2 Fredrickson et al. NEJM 1967; 276: 148

  3. Atherosclerosis Plaque Formation • Endothelial damage occurs • After the endothelium is damaged - LDL particles can enter the Intima. • Once the LDL particles are in the Intima the are modified (oxidized) • Oxidized LDL (causes damage to endothelium which leads to inflammatory response) • Inflammatory response includes the release of cytokines • Cytokines attract – Monocytes and Inflammatory T-cells (they migrate from the blood stream into the artery wall) • Monocytes (once in the intima) transform into Macrophages and take up the oxidized LDL. • LDL laden Macrophages become FOAM CELLS • Foam cells and T-cells send out more cytokines that attract more monocytes, t-cells and platlets.

  4. Intima Media Adventitia Macrophageaccumulation Formation ofnecrotic core Fibrous-capformation Endothelial permeability Leukocyte migration Increased endothelial adhesiveness Leukocyte adhesion Altered Endothelial Function Reproduced with permission fromRoss R. N Engl J Med. 1999;340:115-126.

  5. Metabolic Syndrome • Metabolic Syndrome is diagnosed when >3 of these risk factors are present: • Abdominal obesity • Triglycerides > 150mg/dL • Blood Pressure > 130/ > 85 mm Hg • Fasting Glucose > 100 mg/dL • HDL-C < 40 mg/dL Men or < 50 mg/dL in women • Diabetes is a CHD risk equivalent and that puts the patients in the high-risk category. Patients in the high-risk category have an LDL-C goal of less than100 mg/dL, and an optional goal of less than 70 mg/dL • Individuals with the Metabolic Syndrome are at an increased risk for developing other co-morbid conditions later in life (eg, diabetes mellitus). Ford, ES. Diabetes Care. 2004;27:2444–2449. National Heart, Lung, and Blood Institute. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Executive Summary. National Institutes of Health. Bethesda, MD; 2001. NIH Publication 01-3670.

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