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Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Apolipoprotein C-III predicts cardiovascular mortality in severe coronary artery disease and is associated with an
O Olivieri1, N Martinelli, D Girelli
1Department of Clinical and Experimental Medicine, Unit of Internal Medicine, University of Verona, Verona, Italy. oliviero.olivieri@univr.it
Insights
Elevated apolipoprotein C-III (apo C-III) levels predict cardiovascular mortality in coronary artery disease (CAD) patients. Higher apo C-III is also linked to increased blood clotting potential, suggesting a thrombogenetic role.
Area of Science:
- Cardiovascular Medicine
- Lipid Metabolism
- Hemostasis and Thrombosis
Background:
- Apolipoprotein C-III (apo C-III) is a key regulator of plasma triglyceride (TG) levels.
- Elevated TG-rich lipoproteins are associated with atherogenesis.
- The role of apo C-III in cardiovascular outcomes and thrombotic potential requires further elucidation.
Purpose of the Study:
- To assess the predictive value of serum apo C-III for cardiovascular mortality in patients with coronary artery disease (CAD) undergoing secondary prevention.
- To investigate the association between apolipoprotein levels and endogenous thrombin generation, a measure of plasma thrombotic potential.
Main Methods:
- Prospective follow-up of 633 patients with angiographically confirmed CAD.
- Analysis of cardiovascular and total mortality over a median of 57 months.
- Assessment of apo C-III levels and their correlation with endogenous thrombin potential in a subgroup of patients.
Main Results:
- After adjusting for known mortality predictors, elevated apo C-III levels (≥ 10.5 mg/dL) significantly predicted both total and cardiovascular mortality.
- A significant association was found between apo C-III levels and endogenous thrombin potential (standardized beta = 0.207, P = 0.002).
- The majority of patients (92%) had undergone coronary revascularization prior to follow-up.
Conclusions:
- Basal apo C-III concentrations ≥ 10.5 mg/dL are independent predictors of cardiovascular mortality in CAD patients over a 5-year period.
- Elevated apo C-III levels are associated with enhanced endogenous thrombin generation.
- These findings suggest a dual role for apo C-III in promoting cardiovascular events through lipid metabolism and coagulation pathways.
Background:
Apolipopoprotein C-III (apo C-III) plays a pivotal role in controlling plasma triglyceride (TG) and contributes to the atherogenic properties of TG-rich lipoproteins.
Objectives:
(i) To examine the predictive value of serum apo C-III for cardiovascular mortality in the setting of secondary prevention of coronary artery disease (CAD); and (ii) to evaluate possible associations between apolipoprotein levels and the thrombin generation assay, a global test to estimate plasma thrombogenic potential.
Methods And Results:
A cohort of 633 patients with angiographically proven CAD was prospectively followed for a median follow-up of 57 months. The large majority of them (92%) underwent coronary (endovascular or surgical) revascularization. During the follow-up, 91 (14.3%) out of 633 patients died, with 64 events (10.1%) attributed to cardiovascular causes. After adjustment for all the other predictors of mortality during univariate analysis (i.e. age, statin therapy, myocardial infarction history, diabetes, hs-CRP and creatinine), elevated apo C-III levels (> or = 10.5 mg dL(-1)- the median value) significantly predicted both total and cardiovascular mortality (HR for total mortality 2.22 with 95% CI 1.16-4.24; HR for cardiovascular mortality 2.35 with 95% CI 1.19-4.62). In a subgroup of 225 subjects, apo C-III levels were significantly associated with endogenous thrombin potential in regression models (standardized beta coefficient = 0.207, P = 0.002).
Conclusions:
Basal concentrations of apo C-III levels > or = 10.5 mg dL(-1) in CAD patients independently predicted cardiovascular mortality during the subsequent 5-year period. Such concentrations were associated with an enhanced plasma endogenous thrombin generation, suggesting a complex interplay between TG-rich particles and the coagulation cascade as well as a new 'thrombogenetic' role for apo C-III.
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