Prevalence of Dyslipidemic Phenotypes in Ischemic Heart Disease

The Québec Cardiovascular Study followed French-Canadian men prospectively to identify which lipid phenotypes distinguished those who developed ischemic heart disease from those who did not. This 1995 paper quantified the prevalence of distinct dyslipidemic patterns in each group.

Among men who remained free of IHD, half appeared to have a normal lipid profile. But 68 percent of men who developed IHD had an identifiable dyslipidemia. The patterns that most strongly distinguished cases were the “hyperapoB” phenotypes — elevated apolipoprotein B, whether accompanied by normal or elevated triglycerides. HyperapoB with normal triglycerides conferred 2.7-fold risk; with elevated triglycerides, 3.1-fold risk. Isolated low HDL also predicted risk significantly.

The clinical significance of this phenotyping work was substantial. Many men with “normal” total cholesterol and LDL carried elevated apoB — and those men developed IHD at high rates. The paper made the case for measuring apoB in clinical practice decades before it entered major guidelines, demonstrating that the standard lipid panel was missing a large share of atherogenic risk.

We rate the evidence moderate. Influential prospective cohort data establishing apoB as a superior risk marker, though limited by its single-sex, ethnically homogeneous design and the observational confounders inherent to the Québec cohort.