Discordance Between Apolipoprotein B and LDL-Cholesterol and Incident Hypertension Risk: An Analysis of US Real-World Data

OBJECTIVES: To describe levels of discordance between apolipoprotein B (apoB) and low-density lipoprotein cholesterol (LDL-C) and odds of developing hypertension among adults in a large real-world database.

METHODS: Retrospective cohort study identified adults who had an apoB and LDL-C value within 6 months of each other in the Veradigm Network EHR linked to claims between 1/1/13 and 9/30/22. Level of discordance between apoB and LDL-C was categorized into four mutually exclusive groups using median lab values. The earliest lab was index. Patients had ≥12 months of claims/EHR activity prior to and ≥24 months following index. Incident cardiovascular-related events and medication use were described during a 2-year follow-up. Logistic regression models assessed odds of developing hypertension; log-rank test and Cox proportional hazards model compared rates of incident hypertension between cohorts.

RESULTS: Among 9,028 adults included, most patients were concordant (41% high-risk, 38% low-risk), 11% and 10% were low-risk and high-risk discordant, respectively. Overall, mean (SD) age was 56 (13.5), 55.3% were female, and 57.4% were White. At baseline, mean (SD) BMI was 29.7 (5.9), ASCVD risk was 11.6%, and less than half (44.8%) were on a lipid-lowering medication. During the 2-year follow-up, 22.2% developed hypertension overall, with the discordant high-risk group having the highest rate (27.9%). In adjusted analysis, discordant high-risk group had significantly higher odds of developing hypertension (OR 1.6; 95% CI, 1.2-2.2) compared to concordant low-risk group. Cox proportional hazards models showed that discordant high-risk group was more likely than concordant low-risk group to develop hypertension (HR 1.3; 95% CI, 1.1-1.6 p<0.05).

CONCLUSIONS: We identified a substantial proportion of adults with discordant apoB/LDL-C values. Those in the discordant high-risk group (high apoB, low LDL-C) had the highest risk of incident hypertension. Current lipid screening guidelines miss a substantial proportion of adults at risk for hypertension when relying on standard lipid measures.