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Cumulative Atherogenic Index of Plasma Burden and Risk of Non-Fatal Myocardial Infarction and Ischemic Stroke Beyond
Naoya Inoue1,2, Haruki Kato1, Nao Takahashi1
1Department of Cardiology, Chutoen General Medical Center Shizuoka Japan.
Insights
The cumulative atherogenic index of plasma (cAIP) burden predicts cardiovascular events, even with low cumulative low-density lipoprotein cholesterol (cLDL-C). This lipid risk marker offers complementary value for assessing residual cardiovascular risk.
Area of Science:
- Cardiovascular Medicine
- Lipidology
- Preventive Cardiology
Background:
- Atherogenic Index of Plasma (AIP) indicates atherogenic dyslipidemia.
- The prognostic value of cumulative AIP (cAIP) beyond cumulative LDL-C (cLDL-C) is not well-established.
Purpose of the Study:
- To investigate whether cAIP burden provides prognostic information independent of cLDL-C burden for cardiovascular events.
Main Methods:
- Retrospective analysis of 11,402 adults with at least 3 lipid-complete health checkups.
- Calculation of cAIP and cLDL-C burdens.
- Cox models adjusted for cardiovascular risk factors and cLDL-C, assessing incident myocardial infarction or ischemic stroke.
Main Results:
- Higher cAIP burden was independently associated with increased risk of myocardial infarction or ischemic stroke (HR 1.14).
- Risk progressively increased with higher cAIP burden.
- Low cLDL-C/high cAIP burden identified higher risk compared to low cLDL-C/low cAIP burden.
Conclusions:
- Cumulative AIP burden is associated with incident cardiovascular events.
- cAIP identifies excess risk even with low cLDL-C, highlighting its complementary role in assessing residual lipid-related risk.
Background:
A higher atherogenic index of plasma (AIP; calculated as log10[triglycerides/high-density lipoprotein cholesterol]) is an indicator of atherogenic dyslipidemia. Whether the cumulative AIP (cAIP) burden provides prognostic information beyond the cumulative low-density lipoprotein cholesterol (cLDL-C) burden remains unclear.
Methods And Results:
This retrospective study analyzed data for 11,402 adults with at least 3 health checkups. cAIP and cLDL-C burdens were calculated from the first 3 lipid-complete visits, with the third visit defined as the index date. The primary outcome was first non-fatal myocardial infarction (MI) or ischemic stroke. Cox models were adjusted for conventional cardiovascular risk factors and cLDL-C burden. Over a mean follow-up of 4.96 years, 435 primary events occurred. Per 1-SD increase, cAIP burden was independently associated with the primary outcome after full adjustment including cLDL-C burden (hazard ratio 1.14; 95% confidence interval 1.02-1.27). Restricted cubic splines showed a progressive increase in risk with higher AIP burden. In discordance analysis, low cLDL-C/high cAIP burden, but not high cLDL-C/low cAIP burden, was associated with a higher risk than low cLDL-C/low cAIP burden (hazard ratio 1.40; 95% confidence interval 1.04-1.89). The addition of AIP burden did not improve global discrimination or reclassification.
Conclusions:
cAIP burden was associated with incident non-fatal MI or ischemic stroke and identified excess risk despite low cLDL-C burden, supporting its complementary value for characterizing residual lipid-related risk.
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