The EUROASPIRE IV survey finds lower CETP activity in coronary patients with elevated triglycerides and residual apoB-driven risk (Clin Chim Acta 2026)

Original title: Residual cardiovascular risk is tracked by apolipoprotein B in coronary patients with elevated serum triglyceride levels: the ESC EORP EUROASPIRE IV survey

Clin Chim Acta · 24 October 2025 · 5

Leiviskä J, Sundvall J, Jauhiainen M, Kotseva K, Tuomilehto J, De Backer G, Tokgözoğlu L, Reiner Z, De Bacquer D

Using samples from the 7998-person EUROASPIRE IV survey of coronary patients, researchers compared 938 participants with low total cholesterol (below 4.5 mmol/L) and high triglycerides (1.7 mmol/L or above) against a matched group with low triglycerides (below 1.0 mmol/L), analysing apolipoprotein A-I, apolipoprotein B, and in a random subsample, phospholipid transfer protein, CETP, paraoxonase-1, ANGPTL-3 and ANGPTL-8. Despite lower LDL cholesterol (1.89 versus 1.99 mmol/L), the high-triglyceride group had significantly higher total cholesterol, apolipoprotein B, and HbA1c, alongside significantly lower HDL cholesterol, apolipoprotein A-I, and CETP activity (all P less than 0.001), and higher rates of obesity and diabetes. The authors conclude that apolipoprotein B measurement, rather than LDL cholesterol alone, better captures residual cardiovascular risk from triglyceride-rich, apoB-containing lipoproteins in this atherogenic dyslipidemia phenotype.

Original abstract

Background And Aims: Based on data from the EUROASPIRE IV survey, we aimed at assessing the possible residual risk tracked by serum apolipoprotein B in coronary patients with elevated serum triglycerides.

Methods: All samples from the total EUROASPIRE IV survey (n = 7998) with low serum total cholesterol (<4.5 mmol/L) and high serum triglycerides (≥1.7 mmol/L) were used to analyse apolipoprotein A-I (apoA-I) and apolipoprotein B (apoB) concentrations (n = 938). We selected a similar number of participants (n = 938) with low total cholesterol and with low triglycerides (<1.0 mmol/L). In addition, phospholipid transfer protein (PLTP) and cholesteryl ester transfer protein (CETP) as well as paraoxonase-1 (PON-1), angiopoietin-like (ANGPTL)-3 and ANGPTL-8 were analysed in randomly selected participants.

Results: Despite the lower low-density lipoprotein cholesterol (LDL-C) concentration in the patients with TG ≥ 1.7 mmol/L (1.89 ± 0.44 mmol/L) than those with TG < 1.0 mmol/L (1.99 ± 0.43 mmol/L), p < 0.0001), serum total cholesterol, apoB, and HbA1c were all significantly (p < 0.0001) higher in patients with TG ≥ 1.7 mmol/L. In addition, high-density lipoprotein cholesterol (HDL-C), apoA-I, and CETP activity were significantly lower (p < 0.001) in these patients. The prevalence of obesity and diabetes was higher in the participants with TG ≥ 1.7 mmol/L than in those with TG < 1.0 mmol/L (52.6 % vs 21.9 % and 41.3 % vs. 20.0 %).

Conclusions: Statin treatment is mainly decreasing serum LDL-C concentration, but apoB measurements with excess serum triglycerides carried by apoB-containing lipoproteins could provide more specific information about the risk assessment of cardiovascular disease in atherogenic dyslipidemia.

Summary written by cetpinhibition.org from the published abstract; figures as published. Page updated 19 August 2026. Methods.