SPC365

When Apolipoprotein B Speaks: Early Clues to Coronary Disease Burden

Session: Sessão de Posters 07 - Lípidos para além do LDL: a nova fronteira do risco
Speaker: Francisco Salvaterra

Congress: CPC 2026
Topic: J. Preventive Cardiology
Theme: 28. Risk Factors and Prevention
Subtheme: 28.4 Lipids
Session Type: Posters Eletrónicos
FP Number: ---
Authors: Francisco Salvaterra; Diogo Ferreira; Pedro Alves da Silva; Inês Aguiar-Ricardo; Nelson Cunha; Inês Araújo; João Fernandes Pedro; Catarina Silva; Alda Ribas; Edite Caldeira; Fausto J. Pinto; Ana Abreu

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span><br />
<span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Apolipoprotein B (ApoB) is a key marker of atherogenic lipoproteins and a strong predictor of cardiovascular risk. Recent data suggest that, although seldom measured in clinical practice, it outperforms low-density lipoprotein cholesterol in predicting atherosclerotic cardiovascular disease risk.</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Purpose</strong></span></span></span><br />
<span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">The objective of our study is to assess whether baseline ApoB levels can predict cardiovascular disease severity in patients enrolled in a cardiac rehabilitation program.</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span><br />
<span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">This was a prospective observational single-center study including patients with ischemic coronary artery disease enrolled in a phase II cardiac rehabilitation program between 2023 and 2025. Patients were stratified into two groups based on baseline ApoB levels (&ge;80 mg/dL or &lt;80 mg/dL). Clinical, echocardiographic, and CPET data were collected. A composite outcome of all-cause mortality, cardiovascular hospitalizations, and reinfarction was evaluated.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span><br />
<span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">A total of 151 patients (88% male; 61.1 &plusmn; 10.4 years) with ischemic cardiomyopathy enrolled in the phase II cardiac rehabilitation program. Common comorbidities included hypertension (63.3%), dyslipidemia (72.2%), smoking (31.1% current; 32.5% former), and diabetes (28.7%). At admission, mean ApoB levels were 71.68 &plusmn; 23.16 mg/dL, and 46 patients had levels of at least 80mg/dL.</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Patients with ApoB &ge;80 mg/dL were younger at the start of cardiac rehabilitation (58.3 years [95% CI 55.2&ndash;61.5] vs 62.3 years [95% CI 60.3&ndash;64.3], p=0.031), and, were, therefore, younger at the time of the coronary event. ApoB levels of at least 80mg/dL were also associated with the severity of coronary artery disease. In fact, patients with higher levels of ApoB had twice the odds of having multivessel disease (OR 2.11 [CI 95% 1.03-4.32], p 0.039) and four times the odds of being submitted to coronary artery bypass grafting surgery (OR 4.28 [CI 95% 1.82-10.07], p &lt;0.001). Other clinical variables including weight, BMI, NYHA class, HbA1c, glomerular filtration rate and NT-proBNP levels, 6MWT and CPET parameters were similar between both groups.</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">During a mean follow-up of 1.28 &plusmn; 1.61 years, no statistically significant difference was found between the two groups regarding the composite outcome of all-cause mortality, cardiovascular hospitalizations, and reinfarction, with only three events in each group (p=0.474).</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span><br />
<span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">In our cohort, patients with ApoB &ge;80 mg/dL were younger and had more severe ischemic coronary artery disease, underscoring the value of ApoB as a marker of cardiovascular risk and disease burden. These findings support the broader incorporation of ApoB measurement into routine clinical practice for risk stratification and early identification of high-risk patients.</span></span></span></p>

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