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Paradoxical Association Between Baseline Apolipoprotein B and Prognosis in Coronary Artery Disease: A 36,460 Chinese
Huanqiang Li1,2, Bo Wang1,2, Ziling Mai1,2,3
1Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Insights
This study found that lower Apolipoprotein B (ApoB) levels in coronary artery disease patients were paradoxically linked to worse long-term outcomes. However, after adjusting for malnutrition and bilirubin, higher ApoB concentration remained associated with increased mortality risk.
Area of Science:
- Cardiology
- Biochemistry
- Epidemiology
Background:
- Apolipoprotein B (ApoB) and low-density lipoprotein cholesterol (LDL-C) are key targets for managing blood lipids in coronary artery disease (CAD) patients.
- Previous research indicated an inverse correlation between baseline LDL-C and clinical outcomes, prompting further investigation into ApoB's role.
Purpose of the Study:
- To investigate the definitive association between baseline Apolipoprotein B (ApoB) levels and the long-term prognosis in patients with coronary artery disease (CAD).
Main Methods:
- A cohort of 36,460 CAD patients was divided into high (≥65 mg/dL) and low (<65 mg/dL) baseline ApoB groups.
- Kaplan-Meier analysis, Cox regression, and restricted cubic splines were employed to assess the link between baseline ApoB and all-cause mortality over a median follow-up of 5.01 years.
Main Results:
- Overall mortality was 12.49% (n=4,554). Patients with low baseline ApoB (<65 mg/dL) exhibited a paradoxically worse prognosis.
- After adjusting for CONUT and total bilirubin, the risk of all-cause mortality decreased in the low-ApoB group (aHR: 0.86; 95% CI: 0.78-0.96).
- In the fully adjusted model, the low-ApoB group had a 10% lower risk of long-term all-cause mortality (aHR: 0.90; 95% CI: 0.81-0.99).
Conclusions:
- A paradoxical association exists between baseline ApoB and long-term all-cause mortality in CAD patients, with malnutrition and bilirubin playing mediating roles.
- Increased ApoB concentration demonstrates a linear association with an elevated risk of long-term all-cause mortality.
Background:
Apolipoprotein B (ApoB) and low-density lipoprotein cholesterol (LDL-C) were identified targets for blood lipid management among coronary artery disease (CAD) patients. However, previous studies reported an inverse correlation between baseline LDL-C concentration and clinical outcomes. This study aims to explore the definite association between baseline ApoB and long-term prognosis.
Methods:
A total of 36,460 CAD patients admitted to Guangdong Provincial People's Hospital were enrolled and categorized into two groups: high ApoB (≥65 mg/dL) group and low ApoB (<65 mg/dL) group. The association between baseline ApoB and long-term all-cause mortality was evaluated by the Kaplan-Meier method, Cox regression analyses and restricted cubic splines.
Results:
The overall mortality was 12.49% (n = 4,554) over a median follow-up period of 5.01 years. Patients with low baseline ApoB levels were paradoxically more likely to get a worse prognosis. There was no obvious difference in risk of long-term all-cause mortality when only adjusted for age, gender, and comorbidity (aHR: 1.07, 95% CI: 0.99-1.16). When CONUT and total bilirubin were adjusted, the risk of long-term all-cause mortality would reduce in the low-ApoB (<65 mg/dL) group (aHR: 0.86, 95% CI: 0.78-0.96). In the fully covariable-adjusted model, patients in the ApoB <65 mg/d group had a 10.00% lower risk of long-term all-cause mortality comparing to patients with ApoB ≥65 mg/dL (aHR: 0.90; 95% CI:0.81-0.99).
Conclusion:
This study found a paradoxical association between baseline ApoB and long-term all-cause mortality. Malnutrition and bilirubin mainly mediate the ApoB paradox. Increased ApoB concentration remained linearly associated with an increased risk of long-term all-cause mortality.
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