Correlation between Apolipoprotein B-to-Apolipoprotein A1 Ratio and Total-to-HDL-Cholesterol Ratio in a Healthy Population: Should Castelli Index be Updated?

Daniel Siniawski, Walter Masson, Patricia Sorroche, Liliana Casañas, Juan Krauss




The total cholesterol/HDL cholesterol ratio (TC/HDL-Cr) was proposed as a marker of coronary risk about 25 years ago by Dr. William Castelli and the suggested target was <4.5. The INTERHEART study showed that the ApoB / ApoA ratio is a predictor of cardiovascular events higher than the TC / HDLr. Many laboratories in our country do not have the technology to accurately measure apolipoproteins.


To determine values of TC /HDLr or Castelli index (CI) corresponding to the decile 1 of the ApoB / ApoA ratio (0.43, odds ratio 1) of the INTERHEART study, to identify the optimal cutoff point (OCP) that differentiates between sujects with ApoB / ApoA≤ 0.43 and > 0.43; and propose an updated CI target.

Material and Methods

Apolipoprotein levels were measured by immnuno-phelometry in samples obtained from blood donors. Models of simple linear regression were made to analyze the relationship between the ApoB/ApoA and TC/HDL ratios. A ROC analysis was carried out to evaluate the accuracy of the CI to distinguish between subjects with ApoB / ApoAr ≤0.43 and > 0.43. Subjects with hypertension, vascular disease, diabetes or treated with lipid-lowering drugs were excluded.


A total of 283 subjects were included, 64% men, 31% smokers. General characteristics (mean ± SD): age 41.8 ± 14 years, BMI 26.2 ± 4, TC 199.5 ± 48 mg / dl, HDL 49 ± 13 mg / dl, CI 4.31 ± 1.3, ApoB 95.2 ± 28 mg / dl, ApoA 157.4 ± 32 mg / dl, ApoB / ApoAr 0.62 ± 0.21. In the overall population, the correlation between ApoB / ApoAr and the CI was 0.90 and the ApoB / ApoAr of 0.43 corresponded to an CI of 3.22. The area under the ROC curve of the CI to distinguish between subjects with ApoB/ApoAr  0.43 and > 0.43 was 0.936 (CI 95% 0.897- 0.975) and OPC was 3.238.


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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020