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Impact of Glucose Metabolism Status on the Association between Apolipoprotein A-I and Ischemic Risk in Patients with

Kailun Yan1, Jiawen Li1, Kexin Zhang1

  • 1National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Endocrinology and Metabolism (Seoul, Korea)
|November 7, 2025
PubMed

Insights

In patients with coronary artery disease (CAD), low levels of Apolipoprotein A-I (ApoA-I) increase the risk of major adverse cardiac and cerebrovascular events (MACCE), particularly in those with diabetes mellitus (DM). This highlights ApoA-I

Area of Science:

  • Cardiovascular Medicine
  • Metabolic Disorders
  • Lipidology

Background:

  • Apolipoprotein A-I (ApoA-I) is recognized for its cardioprotective properties.
  • The relationship between ApoA-I and ischemic risk in coronary artery disease (CAD) patients across different glucose metabolism statuses is not well-defined.
  • Understanding this relationship is crucial for risk stratification and potential therapeutic interventions in CAD patients.

Purpose of the Study:

  • To investigate the influence of glucose metabolism status on the association between ApoA-I levels and ischemic risk in CAD patients.
  • To determine if ApoA-I serves as a prognostic marker for adverse cardiovascular events in relation to glycemic control.

Main Methods:

  • A cohort study involving 10,724 consecutive CAD patients who underwent percutaneous coronary intervention.
  • Patients were categorized into diabetes mellitus (DM), pre-diabetes (pre-DM), and normal glucose regulation (NGR) groups.
  • The primary endpoint was major adverse cardiac and cerebrovascular event (MACCE), a composite of death, myocardial infarction, revascularization, and stroke, over a 5-year follow-up period.

Main Results:

  • A significant interaction between ApoA-I levels and glucose metabolism status was observed (P=0.041).
  • In the DM group, an L-shaped association indicated that lower ApoA-I levels correlated with higher MACCE risk (P=0.044).
  • Patients in the lowest ApoA-I quintile had a 1.327-fold increased MACCE risk compared to the lowest-risk group, but no significant association was found in pre-DM or NGR groups.

Conclusions:

  • This study is the first to demonstrate that low ApoA-I levels are significantly associated with increased MACCE risk in CAD patients with DM.
  • ApoA-I may serve as a valuable biomarker for risk stratification in diabetic CAD patients.
  • Targeting ApoA-I could represent a potential therapeutic strategy for reducing cardiovascular events in this population.
Abstract

Keywords:
Apolipoprotein A-IDiabetes mellitusGlucose metabolism statusesIschemic riskPercutaneous coronary intervention

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