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The LDL-C/ApoB ratio predicts cardiovascular and all-cause mortality in the general population
Li Xiao1, Kerui Zhang1, Fang Wang1
1Center for Cardiovascular Disease, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Guangji Road, Jiangsu, 215002, Suzhou, China.
Insights
The LDL-C/ApoB ratio (LAR) can predict cardiovascular and all-cause mortality in adults. Lower LAR is an independent risk factor for mortality, especially in individuals over 65.
Area of Science:
- Cardiology
- Preventive Medicine
- Biostatistics
Background:
- Low-density lipoprotein (LDL) particle size is often inferred from the LDL cholesterol to apolipoprotein B ratio (LAR).
- While LAR predicts cardiovascular disease, its association with mortality in the general population remains unclear.
- This study investigates LAR's predictive ability for cardiovascular and all-cause mortality in American adults.
Purpose of the Study:
- To determine if the LDL-C/ApoB ratio (LAR) is associated with cardiovascular mortality.
- To assess the association between LAR and all-cause mortality in the general population.
- To explore potential interactions, such as with age, in the LAR-mortality relationship.
Main Methods:
- Secondary analysis of National Health and Nutrition Examination Survey (NHANES) data (2005-2014).
- Included 12,440 participants; survival analysis used Kaplan-Meier curves and Cox regression.
- Subgroup analyses considered age, sex, comorbidities, and medication use.
Main Results:
- Lower LAR was significantly associated with increased cardiovascular mortality (HR=0.304) and all-cause mortality (HR=0.408).
- A significant interaction with age was observed, with a stronger association in individuals over 65.
- An inverse relationship between LAR and mortality risk was confirmed.
Conclusions:
- The LDL-C/ApoB ratio (LAR) serves as an independent predictor of both cardiovascular and all-cause mortality.
- LAR's predictive value is particularly pronounced in older adults.
- These findings support LAR's utility in risk stratification for the general population.
Background:
Generally, low-density lipoprotein (LDL) particle size can be inferred from the LDL cholesterol concentration to total apolipoprotein B concentration ratio (LDL-C/ApoB ratio, hereinafter called LAR), which is a good predictor of cardiovascular disease. However, the predictive ability of LAR for mortality risk in the general population is still unclear. This study aimed to explore the association between LAR and cardiovascular as well as all-cause mortality among American adults.
Methods:
The present study was a secondary analysis of existing data from the National Health and Nutrition Examination Survey (NHANES). The final analysis included 12,440 participants from 2005 to 2014. Survival differences between groups were visualized using Kaplan‒Meier curves and the log-rank test. The association of LAR with cardiovascular and all-cause mortality was evaluated using multivariate Cox regression and restricted cubic spline analysis. Age, sex, coronary artery disease, diabetes, lipid-lowering medication use and hypertriglyceridemia were analyzed in subgroup analyses.
Results:
The median age in the study cohort was 46.0 years [interquartile range (IQR): 31.0-62.0], and 6,034 (48.5%) participants were male. During the follow-up period, there were 872 (7.0%) all-cause deaths and 150 (1.2%) cardiovascular deaths. Compared with individuals without cardiovascular events, those who experienced cardiovascular deaths had a lower LAR (1.13 vs. 1.25) (P < 0.001). The adjusted Cox regression model indicated that lower LAR was an independent risk factor for both cardiovascular [hazard ratio (HR) = 0.304, 95% confidence interval (CI): 0.114-0.812] and all-cause mortality (HR = 0.408, 95% CI: 0.270-0.617). Moreover, a significant age interaction was observed (P for interaction < 0.05), and there was a strong association between LAR and mortality among participants over 65 years of age. Further analysis showed an inverse association between LAR and both cardiovascular and all-cause mortality.
Conclusions:
LAR can independently predict cardiovascular and all-cause mortality in the general population.
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