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Published on: January 28, 2020
Apolipoproteins and long-term prognosis in coronary heart disease patients
Michal Benderly1, Valentina Boyko, Uri Goldbourt
1The Israel Society for the Prevention of Heart Attacks, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel-Hashomer, Israel. bender@post.tau.ac.il
Insights
Apolipoproteins and lipoprotein cholesterol similarly predict long-term mortality in coronary heart disease patients. Measuring apolipoproteins offers an acceptable alternative for assessing prognosis in these individuals.
Area of Science:
- Cardiovascular Disease Research
- Biomarker Discovery
- Clinical Prognostics
Background:
- Emerging evidence suggests apolipoproteins as potential predictors of cardiovascular risk, an alternative to traditional lipoproteins.
- Limited data exist on the added prognostic value of apolipoproteins in patients with coronary heart disease (CHD).
- This study investigates the association between lipoprotein cholesterol, related apolipoproteins, and long-term mortality in CHD patients.
Purpose of the Study:
- To evaluate the predictive capability of apolipoproteins compared to lipoprotein cholesterol for long-term mortality in coronary heart disease (CHD) patients.
- To determine if apolipoprotein measurements offer a viable alternative to blood lipid analysis for CHD prognosis.
Main Methods:
- A cohort of 4,472 men and 624 women (aged 40-74) with specific lipid profiles was followed for a median of 12.3 years.
- Participants were from the placebo arm of the Bezafibrate Infarction Prevention study.
- Statistical analyses examined the association between lipid and apolipoprotein levels and mortality, adjusting for various clinical factors.
Main Results:
- Apolipoproteins A-I and B showed associations with mortality comparable to their corresponding lipids (HDL-C and non-HDL-C).
- After adjusting for confounders, risk estimates for upper vs. lower tertiles were similar for both lipid and apolipoprotein measures.
- Models incorporating either apolipoproteins or cholesterol subfractions demonstrated equivalent predictive power for mortality.
Conclusions:
- Lipoprotein cholesterol and associated apolipoproteins possess similar abilities in predicting long-term mortality among CHD patients.
- Apolipoprotein measurement is a suitable alternative to blood lipid assessment for evaluating prognosis in coronary heart disease.
- Findings support the use of apolipoproteins as reliable biomarkers for cardiovascular risk stratification.
Background:
Apolipoproteins have been recently suggested as an alternative to lipoproteins in prediction of cardiovascular risk. Data regarding their added value in predicting the prognosis of coronary heart disease (CHD) patients are scarce. Our aim was to examine the association between lipoprotein cholesterol and related apolipoproteins with long-term mortality among CHD patients.
Methods:
Patients (4,472 men; 624 women, 40-74 years old) with total cholesterol <270 mg/dL (<7.0 mmol/L), high-density lipoprotein cholesterol (HDL-C) <45 mg/dL (<1.16 mmol/L), and triglycerides <300 mg/dL (< or =3.39 mmol/L); excluded from the Bezafibrate Infarction Prevention study; or included in the placebo arm were followed up for a median of 12.3 years.
Results:
Among both men and women, the association of apolipoproteins A-I and B with mortality was comparable to their corresponding lipids (HDL-C, non-HDL-C respectively). Adjusting for age, disease history, comorbidities, smoking and baseline glucose, the risk associated with the upper versus the lower tertile (lower vs upper for HDL-C and apolipoprotein A-I) among men were 1.04 (95% CI 0.91-1.19) for non-HDL-C; 1.11 (0.97-1.27) for apolipoprotein B; 1.24 (1.09-1.41) for HDL-C; and 1.30 (1.14-1.49) for apolipoprotein A-I. Atherogenic to nonatherogenic particle ratios (lipids or apolipoproteins) were in line with the results of their individual components pointing to a less atherogenic profile among women. Models including either apolipoprotein or cholesterol subfractions had similar predictive power.
Conclusion:
Lipoprotein cholesterol and associated apolipoprotein have comparable ability to predict long-term mortality. The measurement of apolipoproteins constitutes an acceptable alternative to the use of blood lipids in assessing prognosis for CHD patients.
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