Introduction: ABO blood types have been shown to associate with the incidence of thrombotic vascular diseases. A, B and AB blood types, or non-O blood types, refer to erythrocytes that contain A, B, or both antigens, whereas O blood type contains neither A nor B antigens. Non-O blood types are associated with higher incidence of coronary heart disease (CHD), plasma total cholesterol and low-density lipoprotein (LDL) cholesterol levels compared to O blood type, independent of age, smoking, BMI, family history of CHD, and menopause. Full length apolipoprotein-B (apoB-100) is the scaffolding protein of LDL. Apolipoprotein (a) (apo(a)) binds to apoB-100 with a disulfide bond to assemble lipoprotein (a) (Lp(a)). Both LDL and Lp(a) are the main drivers of cardiovascular and cerebral vascular diseases, which are leading causes of death worldwide. However, the levels of apoB-100 and apo(a) in ABO blood types have not been reported.

Objectives: Given that non-O blood is associated with a higher incidence in CHD than O blood, we will test the hypothesize that non-O blood types have higher apoB-100 and apo(a) levels than O-type blood.

Methods: Through the Versiti Blood Center of Wisconsin blood bank, we collected de-identified whole blood samples from donors between ages 18-40, equally distributed by sex, and following the same distribution of ABO blood type in the US (blood type A with 39%, B 12%, AB 4%, and O 45%). In this study, we applied a power analysis using one-way ANOVA to obtain a sample size of blood samples from 340 individuals (α = 0.05, power = 0.85, effect size = 0.198). Whole blood samples were centrifuged at 1500 g for 15 minutes to isolate plasma. ELISAs were used to determine plasma apoB-100 and apo(a) concentrations. P values were determined by Welch's t-test and Mann-Whitney U Test for apoB-100 and apo(a), respectively.

Results: In this cohort containing 340 healthy blood donors, apoB-100 concentrations did not differ between O and non-O blood types (non-O = 73.05 mg/dL, O = 72.24 mg/dL, p = 0.8172). When comparing by blood types, there were no difference in mean apoB-100 concentration neither (A = 75.19 mg/dL, B = 70.25 mg/dL, AB = 69.24 mg/dL, O = 71.66 mg/dL, p = 0.6319). Similarly, the median apo(a) levels do not differ between O and non-O blood types (non-O = 6 mg/dL, O = 5.71 mg/dL, p= 0.3643) or between blood type groups (A = 6.05 mg/dL, B = 5.59 mg/dL, AB = 5.97 mg/dL, O = 5.74 mg/dL, p = 0.6213).

Conclusion: In this study, the levels of apoB-100 and apo(a) concentrations do not differ between non-O and O blood types, nor among the ABO blood types. Given that the association between non-O blood groups and thrombotic vascular diseases is well established, and apoB-containing lipoproteins are the main drivers of these diseases, the lack of difference in apoB-100 and apo(a) concentrations between blood groups is paradoxical. Future prospective investigation should delineate whether this relationship is independent of apoB-100 or apo(a) and to reveal the underlying mechanism of the protective role in O-blood type from thrombotic vascular diseases.

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2025
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