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Atherogenic Index of Plasma Predicts the Onset and Progression of Cardio-Renal-Metabolic Multimorbidity: Evidence
Jijie Jin1,2, Fei Wang2, Shengzhang Chen2
1The Center of Gerontology and Geriatrics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
Insights
The atherogenic index of plasma (AIP) predicts cardio-renal-metabolic (CRM) multimorbidity onset and progression. Higher AIP levels are linked to increased risks of developing single, dual, or triple CRM conditions.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Endocrinology
- Lipidology
Background:
- Cardio-renal-metabolic (CRM) multimorbidity, encompassing cardiovascular disease (CVD), chronic kidney disease (CKD), and type 2 diabetes (T2DM), presents a significant challenge in disease management.
- The atherogenic index of plasma (AIP), a lipid-based marker reflecting insulin resistance, is a potential predictor of CRM progression, though its prognostic value requires further clarification.
Purpose of the Study:
- To investigate the prognostic value of AIP in predicting the onset and progression of CRM multimorbidity.
- To assess the association between AIP levels and the risk of developing single, dual, or triple CRM conditions.
Main Methods:
- Utilized data from 5805 adults without CRM at baseline from the China Health and Retirement Longitudinal Study.
- Calculated AIP as log10(triglyceride/high-density lipoprotein cholesterol) and defined CRM onset as incident CVD, T2DM, or CKD.
- Employed multistate models, Cox regression, and time-dependent ROC curves to analyze CRM transitions and predictive performance.
Main Results:
- AIP demonstrated a dose-response relationship with CRM progression; each 1-SD increase in AIP correlated with elevated risks of single (HR 1.17), dual (HR 1.31), and triple CRM (HR 1.57).
- Significant associations were found for new-onset T2DM and stroke, but not CKD.
- AIP showed the highest predictive discrimination for triple CRM (5-year AUC=0.710), with multistate models indicating increased hazard ratios for transitions between CRM states.
Conclusions:
- AIP serves as an independent, straightforward, and cost-effective predictor for CRM onset and progression.
- AIP holds potential utility for early risk stratification and the implementation of preventive strategies for CRM multimorbidity.
Background:
Cardio-renal-metabolic (CRM) multimorbidity, defined by the co-occurrence of cardiovascular disease (CVD), chronic kidney disease (CKD), and type 2 diabetes (T2DM), poses a growing burden for multimorbidity management. The atherogenic index of plasma (AIP), a lipid-based marker of insulin resistance, may help predict CRM progression, but its prognostic value remains unclear.
Methods:
We used data from 5805 adults free of CRM at baseline in the China Health and Retirement Longitudinal Study. AIP was calculated as log10[triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C)]. CRM onset was defined as incident CVD, T2DM, or CKD. Multistate models captured transitions from no disease to single, dual, and triple CRM states. Cox regression and time-dependent receiver operating characteristic (ROC) curves were used to assess associations and predictive performance.
Results:
AIP showed a clear dose-response relationship with CRM progression. Each 1-standard deviation (SD) increase in AIP was associated with higher risks of single (HR 1.17, 95% CI 1.13-1.22), dual (HR 1.31, 95% CI 1.21-1.41), and triple CRM (HR 1.57, 95% CI 1.27-1.94) diseases. Strong associations were observed for new-onset T2DM and stroke, but not CKD. AIP yielded the highest discrimination for triple CRM (5-year area under the curve [AUC] = 0.710). Multistate modeling showed each 1-SD increase in AIP raised the hazard of transitioning from single to dual CRM by 14% and from dual to triple by 31%.
Conclusions:
AIP is an independent, simple, and low-cost predictor of CRM onset and progression, with potential utility for early risk stratification and prevention.
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