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Risk Factors, Risk Prediction, and the Apolipoprotein B–Apolipoprotein A-I Ratio

Michael Berkwits, MD, MSCE, Deputy Editor; and Eliseo Guallar, MD, PhD
[+] Article, Author, and Disclosure Information

From the American College of Physicians, Philadelphia, PA 19106, and Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Customer Service, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.

Current Author Addresses: Dr. Berkwits: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.

Dr. Guallar: Johns Hopkins University Bloomberg School of Public Health, 2024 East Monument Street, Baltimore, MD 21205.

Ann Intern Med. 2007;146(9):677-679. doi:10.7326/0003-4819-146-9-200705010-00012
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In this issue, van der Steeg and colleagues report the results of a nested case–control study demonstrating that the apolipoprotein B–apolipoprotein A-I (apo B–apo A-I) ratio is a risk factor for future coronary events, independent of low-density lipoprotein cholesterol level, high-density lipoprotein cholesterol level, and other traditional risk factors (1). The study also suggests that the apo B–apo A-I ratio negligibly improves overall risk prediction compared with conventional coronary risk factors and the Framingham risk score. This latter finding contradicts an emerging literature that enthusiastically endorses the apo B–apo A-I ratio as an improved measure of risk (25). It is a good reminder that individual risk factors for important diseases are rarely useful for risk prediction and clinical decision making. We review the reasons why.

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