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Coronary artery disease in patients at low risk--apolipoprotein AI as an independent risk factor
1Department of Pathology and Laboratory Medicine, Healthy Heart Program, University of British Columbia, St. Paul's Hospital, 180-1081 Burrard St., BC, V6Z 1Y6, Vancouver, Canada.
Insights
Apolipoprotein-AI (apoAI) may be an independent risk factor for coronary artery disease (CAD) in low-risk individuals. Lower apoAI levels were linked to CAD, even without major risk factors, suggesting a role in atherosclerosis.
Area of Science:
- Cardiovascular Medicine
- Biochemistry
- Epidemiology
Background:
- Established coronary artery disease (CAD) risk factors do not explain all cases.
- Preliminary findings suggest apolipoprotein-AI (apoAI) may be lower in patients with CAD despite lacking major risk factors.
Purpose of the Study:
- To investigate if apolipoprotein-AI (apoAI) is an independent risk factor for CAD in low-risk populations.
- To determine the predictive value of apoAI for CAD in individuals without traditional risk factors.
Main Methods:
- 1075 consecutive patients undergoing angiography were analyzed.
- A subgroup of 54 low-risk patients (defined by cholesterol, blood pressure, diabetes, and family history) were selected.
- Multivariate analysis was performed on lipid profiles, including apoAI and HDL cholesterol.
Main Results:
- Serum apoAI level was the sole predictor of CAD in low-risk patients after adjusting for age and gender.
- This association was independent of high-density lipoprotein (HDL) cholesterol levels and its fractional esterification rate (FER(HDL)).
- 29 out of 54 low-risk patients had evidence of CAD, with lower apoAI levels.
Conclusions:
- Apolipoprotein-AI (apoAI) plays a significant role in the atherogenic process, particularly in individuals without major CAD risk factors.
- Decreased apoAI or LpAI levels may initiate atherosclerosis in a select group of low-risk patients.
- apoAI represents a potential novel biomarker for CAD risk assessment in specific populations.
Abstract:
Many risk factors for coronary artery disease (CAD) have been established by large epidemiological studies. However, some patients without the major risk factors still develop disease. Preliminary analysis of individuals referred for angiography, who had no major risk factors associated with CAD, indicated that apolipoprotein-AI (apoAI) was significantly lower in patients with positive angiograms. The hypothesis that apoAI was an independent risk factor for CAD in low risk populations was put forth. One thousand and seventy-five consecutive patients underwent angiography, lipid analysis, and completed a risk factor questionnaire. Individuals with total cholesterol<5.2 mmol/l, high density lipoprotein (HDL)-cholesterol>0.9 mmol/l, systolic blood pressure<140 mmHg and diastolic blood pressure<90 mmHg, no diabetes, and no family history of premature CAD in first degree relatives were selected. Fifty-four patients met these selection criteria, 29 having positive evidence of CAD and 25 with no evidence of disease. Multivariate analysis revealed that, after adjusting for age and gender, serum apoAI level was the only variable predictive of CAD. This effect was independent of HDL cholesterol level and fractional esterification rate of HDL (FER(HDL)). These results point to an important role for apoAI in the atherogenic process, particularly in populations with no major CAD risk factors. Decreased levels of apoAI or LpAI may initiate atherosclerosis in a highly selected group of low risk patients.