Marston NA, Giugliano RP, Melloni GEM, et al. - The number of apolipoprotein B (apoB)-containing lipoproteins best captures the risk of myocardial infarction, independent from lipid content (cholesterol or triglyceride) or type of lipoprotein (low-density lipoprotein or triglyceride-rich). Findings imply apoB could represent the primary driver of atherosclerosis and that treatment strategies should focus on decreasing the level of all apoB-containing lipoproteins.

• A prospective cohort analysis in which people from the population-based UK Biobank and from 2 large international clinical trials were analyzed: 389,529 persons in the primary prevention group who were not on lipid-lowering therapy and 40,430 patients with established atherosclerosis who were taking statins.

• ApoB was revealed to be the only lipid parameter significantly related to risk of myocardial infarction post-adjustment (adjusted hazard ratio per 1 SD, 1.27; 95% CI, 1.15-1.40; P < .001).

• No relationship was identified between the ratio of lipoprotein types and myocardial infarction, suggesting that, for a given number of apoB-containing lipoproteins, one type may not be related to elevated risk.