Association of Apolipoproteins B and A-1 With Markers of Vascular Health or Cardiovascular Events

Validation of the role of apolipoproteins in coronary artery disease patients with impaired kidney function for prognosis: a prospective cohort study in China

OBJECTIVE

This study aims to evaluate the relationship between apolipoproteins (ApoA1, ApoB, and the ApoB/A1 ratio) and the incidence of major adverse cardiovascular events (MACE) in patients with coronary artery disease (CAD) and impaired kidney function, assessing their potential role in secondary prevention.

METHOD

A prospective cohort of 1,640 patients with impaired kidney function who underwent percutaneous coronary intervention in China was analyzed. Patients were categorized based on the measurements of ApoA1, ApoB, and ApoB/A1 ratio. MACE, defined as a composite of all-cause mortality, cardiovascular death, nonfatal myocardial infarctions, strokes, and unplanned revascularizations, was tracked post-procedure, with statistical analyses including Kaplan-Meier survival curves and Cox regression models to identify associations with apolipoproteins. Subgroup analyses according to kidney function were conducted.

RESULT

During a median follow-up of 3.1 years, 324 MACE events were observed. Multivariable Cox regression analyses illustrated higher levels of ApoB and the ApoB/A1 ratio were significantly associated with increased MACE incidence (adjusted HR [95%CI] 1.668[1.044-2.666]; adjusted HR [95%CI] 2.231[1.409-3.533], respectively), while lower ApoA1 levels correlated with a higher risk (adjusted HR [95%CI] 0.505[0.326-0.782]). ROC curve analyses indicated comparable predictive performances to traditional risk factors like LDL cholesterol. Subgroup analysis revealed that the above association was not statistically significant in the moderate-to-severe renal impairment CAD patients (eGFR < 45 mL/min/1.73 m2).

CONCLUSION

Our findings illustrate that apolipoproteins, specifically ApoA1 and ApoB, along with their ratio, are significant predictors of major adverse cardiovascular events in CAD patients with impaired kidney function. These results emphasize the need for incorporating apolipoprotein measurements in secondary prevention strategies for this high-risk population.

Association of apolipoprotein B with all-cause and cardiovascular mortality among adults: Results from the National Health and Nutrition Examination Surveys

BACKGROUND

Apolipoprotein B (apoB) is a crucial component that directly reflects the number of atherogenic lipoprotein particles and is closely related to atherosclerosis. However, there was an inconsistency among previous studies in its relationship with mortality. Using nationally representative data, we aimed to investigate the association of apoB with cardiovascular and all-cause mortality.

METHODS

We retrospectively included participants from the National Health and Nutrition Examination Survey (2007-2014), and mortality was ascertained through December 31, 2015. Hazard ratios (HRs) with 95% confidence intervals (CIs) of apoB in quartiles (Q1-Q4) for mortality risk were calculated using multivariable-adjusted Cox proportional hazards models, and restricted cubic spline regressions were performed to test dose relationships.

RESULTS

We enrolled 10,375 participants with a mean age of 46.3 years, of which 47.88% were men. During a mean follow-up time of 69.2 months, 533 (5.14%) and 91 (0.88%) deaths were due to all causes and cardiovascular disease, respectively. After adjusting for confounders, per SD, increment of apoB was associated with an elevated risk of cardiovascular mortality (HR, 1.13; 95% CI, 1.03-1.24). The risk of all-cause mortality was significantly reduced in the third quartile (Q3) of apoB (HR, 0.71; 95% CI, 0.56-0.91) compared with the reference quartile (Q1). Moreover, spline analyses showed that the relationship of apoB with all-cause mortality was U-shaped, and the threshold value was 108 mg/dL.

CONCLUSIONS

ApoB was linearly associated with increased risk of cardiovascular mortality and non-linearly associated with all-cause mortality in a U-shaped manner, independently of other cardiovascular risk factors.

Lipid Biomarkers and Atherosclerosis-Old and New in Cardiovascular Risk in Childhood

Lipids are a complex group of molecules in the body, essential as structural, functional and metabolic components. When disbalanced, they are regarded as a cardiovascular risk factor, traditionally in cholesterol level evaluation. However, due to their complex nature, much research is still needed for a comprehensive understanding of their role in atherosclerosis, especially in the young. Several new lipid biomarkers are emerging, some already researched to a point, such as lipoproteins and apolipoproteins. Other lipid molecules are also being increasingly researched, including oxidized forms due to oxidative inflammation in atherosclerosis, and sphingolipids. For many, even those less new, the atherogenic potential is not clear and no clinical recommendations are in place to aid the clinician in using them in everyday clinical practice. Moreover, lipids' involvement in atherogenesis in children has yet to be elucidated. This review summarizes the current knowledge on lipids as biomarkers of cardiovascular risk in the paediatric population.

Predictive value of the apolipoprotein B/A1 ratio in intracerebral hemorrhage outcomes

Background and Aims

The apolipoprotein B (apoB)/apolipoprotein A1 (apoA1) ratio is a key indicator in predicting future cardiovascular outcomes. However, it is still unclear whether the ratio of apoB/apoA1 is a better predictor of the outcomes after intracerebral hemorrhage (ICH). Therefore, we aimed to assess the relationships between the ratio of apoB/apoA1 and functional outcomes, all‐cause mortality, and stroke recurrence in ICH patients.

Methods

Two hundred and sixteen Chinese ICH patients participated in this study from December 2018 to December 2019. Laboratory routine tests including hematology analysis, coagulation tests, and lipid levels were examined. The clinical outcomes included functional outcomes evaluated by the modified Rankin Scale score (mRS), all‐cause death, and stroke recurrence 1 year after discharge. Associations between the apoB/apoA1 ratio and the outcomes were evaluated using logistic regression analysis. Based on multivariate analysis, we constructed a nomogram. Univariate survival analysis was performed by the Kaplan–Meier method and log‐rank test. All the patients were classified into two groups by the median value of the apoB/apoA1 ratio: B1 < 0.8 and B2 ≥ 0.8.

Results

Of the 216 patients, 107 had an apoB/apoA1 ratio ≥ 0.8. Eighty‐five patients had poor functional outcomes (mRS ≥ 3), and 32 patients had severe functional outcomes (mRS ≥ 4). During the 1‐year follow‐up, a total of 18 patients died, and 13 patients had apoB/apoA1 ratio levels ≥0.8 during the 1‐year follow‐up period. Moreover, 16 recurrent strokes were recorded. Adjustments for age, sex, smoking, alcohol, body mass index, lipid levels, and hematoma site and volume showed that a high apoB/apoA1 ratio was significantly related to adverse functional outcomes and all‐cause mortality. The ORs for B2 versus B1 were 3.76 (95% CI: 1.37 to 10.40, p = 0.010), 22.74 (95% CI: 1.08 to 474.65, p = 0.044), and 7.23 (95% CI: 1.28 to 40.88, p = 0.025) for poor functional outcomes with mRS ≥ 3, mRS ≥ 4, and all‐cause mortality, respectively.

Conclusion

An increased apoB/apoA1 ratio at admission was independently related to poor functional outcome and all‐cause mortality in ICH patients at the 1‐year follow‐up.

LRP1 polymorphisms associated with warfarin stable dose in Chinese patients: a stepwise conditional analysis

Aim: The aim of this study was to investigate whether variability in warfarin stable dose (WSD) could be influenced by vitamin K-related polymorphisms in patients with heart valve replacement. Patients & methods: Twenty-nine vitamin K-related SNPs in 208 patients who initially took warfarin and achieved WSD were genotyped. Results: After conducting conditional analysis for both VKORC1 -1639G>A and CYP2C9*3, LRP1 rs1800139 and LRP1 rs1800154 were significantly associated with WSD (p = 0.007 and p = 0.015, respectively). Multivariate analysis showed that LRP1 rs1800139 accounted for 5.9% WSD variability. Conclusion: Our results suggest that a novel vitamin K-related gene, LRP1, exerts a relevant influence on WSD, independent of VKORC1 -1639G>A and CYP2C9*3.

LRP1 and APOA1 Polymorphisms: Impact on Warfarin International Normalized Ratio-Related Phenotypes

Warfarin international normalized ratio (INR)-related phenotypes such as the percentage of INR time in the therapeutic range (PTTR) and INR variability are associated with warfarin adverse reactions. However, INR-related phenotypes greatly vary among patients, and the underlying mechanism remains unclear. As a key cofactor for coagulation proteins, vitamin K can affect warfarin INR values. The aim of this study was to address the influence of vitamin K-related single-nucleotide polymorphisms (SNPs) on warfarin INR-related phenotypes. A total of 262 patients who were new recipients of warfarin therapy and followed up for 3 months were enrolled. Twenty-nine SNPs were genotyped by matrix-assisted laser desorption/ionization time-of-flight mass array. Sixteen warfarin INR-related phenotypes were observed. After association analysis, 11 SNPs were significantly associated with at least one INR-related phenotype, and 6 SNPs were associated with at least 2 INR-related phenotypes (P < 0.05). In these SNPs, rs1800139, rs1800154, rs1800141, and rs486020 were the most representative. rs1800139, rs1800154, and rs1800141 locate in LRP1 and were found to be correlated with 1-month and 2-month INR variability (P < 0.05). Besides, the APOA1 rs486020 was significantly associated with the first month PTTR (P = 0.009), and patients with C-allele had higher PTTR than those with G-alleles almost during the entire monitoring period. In conclusion, the study revealed that the polymorphisms of LRP1 and APOA1 gene may play important roles in the variation of warfarin INR-related phenotypes. Our results provide new information for improving warfarin anticoagulation management.

Vitamin D status and cardiometabolic risk markers in young Swedish children: a double-blind randomized clinical trial comparing different doses of vitamin D supplements

BACKGROUND

Observational studies have linked low vitamin D status to unfavorable cardiometabolic risk markers, but double-blinded vitamin D intervention studies in children are scarce.

OBJECTIVES

The aim was to evaluate the effect of different doses of a vitamin D supplement on cardiometabolic risk markers in young healthy Swedish children with fair and dark skin.

METHODS

Cardiometabolic risk markers were analyzed as secondary outcomes of a double-blind, randomized, milk-based vitamin D intervention trial conducted during late fall and winter in 2 areas of Sweden (latitude 63°N and 55°N, respectively) in both fair- and dark-skinned 5- to 7-y-old children. During the 3-mo intervention, 206 children were randomly assigned to a daily milk-based vitamin D3 supplement of either 10 or 25 µg or placebo (2 µg; only at 55°N). Anthropometric measures, blood pressure, serum 25-hydroxyvitamin D [25(OH)D], total cholesterol, HDL cholesterol, apoA-I, apoB, and C-reactive protein (CRP) were analyzed and non-HDL cholesterol calculated at baseline and after the intervention.

RESULTS

At baseline, serum 25(OH)D was negatively associated with systolic and diastolic blood pressure (β = -0.194; 95% CI: -0.153, -0.013; and β = -0.187; 95% CI: -0.150, -0.011, respectively). At follow-up, there was no statistically significant difference in any of the cardiometabolic markers between groups.

CONCLUSIONS

We could not confirm any effect of vitamin D supplementation on serum lipids, blood pressure, or CRP in healthy 5- to 7-y-old children. The study was registered at clinicaltrials.gov (NCT01741324).

Higher chocolate intake is associated with longer telomere length among adolescents

BACKGROUND

Chocolate intake has shown cardiometabolic health benefits. Whether chocolate has any effect on cellular aging remains unknown. We aimed to test the hypothesis that higher chocolate intake is associated with longer leukocyte telomere length (LTL) in adolescents.

METHODS

A total of 660 adolescents (aged 14-18 years) were included in the analysis. The chocolate intake was assessed by 7-day, 24-h dietary recalls and split into three groups, which were none, <2 servings/week, and 2 servings/week or more. LTL (T/S ratio) was determined by a modified quantitative polymerase chain reaction-based assay.

RESULTS

Among the 660 adolescents, 58% did not take any chocolate, 25% consumed <2 servings/week, and 17% consumed ≥2 servings/week. Compared to non-consumers, adolescents who consumed chocolate of ≥2 servings/week had 0.27 standard deviation (SD) longer LTL (p = 0.014). Higher chocolate consumption was associated with increased apolipoprotein A1 (ApoA1) (p = 0.038) and ApoA1/high-density lipoprotein (HDL) (p = 0.046). Moreover, higher ApoA1/HDL levels were correlated with longer LTL (p = 0.026).

CONCLUSION

Adolescents who consume 2 servings/week or more of chocolate candy have longer LTL compared with non-consumers, and ApoA1/HDL pathway may be involved in this relationship.

Age, Sex, and Cardiovascular Risk Attributable to Lipoprotein Cholesterol Among Chinese Individuals with Coronary Artery Disease: A Case-Control Study

Aim: To understand age- and gender-related differences and secular trends in coronary artery disease (CAD) lipid profiles and the characteristic of dyslipidemia in western China. Methods: An age-matched case-control study, including 2400 patients and 1200 controls was performed. All blood lipid tests evaluated from January 2012 to January 2015 at First Affiliated Hospital of Xinjiang Medical University were analyzed. Details of the gender and age of the patients were available. Trends were calculated using linear regression and Mantel-Haenszel X² analyses. Results: We determined the associations among total cholesterol (TC), triglycerides (TGs), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A-1 (apoA-1), apolipoprotein B (apoB), nonhigh-density lipoprotein cholesterol (non-HDL-C), and high-density lipoprotein cholesterol (HDL-C) with CAD for different ages and gender. Except for patients who were <40 years old, the plasma levels of TC, TG, LDL-C, non-HDL-C, apoB, and apoB/apoA-1 were higher in the cases than in controls, and the average levels of these markers decreased significantly as age increased. In contrast, the levels of apoA-1 and HDL-C were significantly higher in the controls than in the patients, and the levels of these markers significantly increased as age increased. Women had higher levels of TC, LDL-C, non-HDL-C, and apoB and a higher value of the apoB/apoA-1 ratio compared to men. The decrease in the average levels of these markers with age was significantly lower in women compared to men. Logistic regression was used to compute the odds ratio of CAD for a one standard deviation change in each lipid marker. Most notably, the apoB/apoA-1 ratio could be a strong risk factor for CAD, and increasing values of the ratio showed a curved line for the graph of the relationship between the ratio and risk. Conclusions: Our results confirmed that serum lipid levels in patients with CAD varied by age and gender. The apoB/apoA-1 ratio remains a strong risk factor for CAD.

Prognostic Significance of Pretreatment Apolipoprotein A-I as a Noninvasive Biomarker in Cancer Survivors: A Meta-Analysis

Background

Numerous studies have reported the prognostic significance of serum apolipoprotein A-I (ApoA-I) in various cancers, but the results have been inconsistent. The current meta-analysis was performed to investigate the association between ApoA-I level and prognosis in human malignancies.

Methods

A literature search was performed using the electronic platforms of the PubMed, Cochrane Library, Web of Science, Embase, Wanfang, and China National Knowledge Infrastructure (CNKI) databases to obtain eligible articles published up to May 20, 2018. Pooled hazard ratios (HRs) with 95% confidence intervals (95% CIs) were calculated to assess the prognostic values of the ApoA-I level in cancers using STATA 12.0 software.

Results

A total of 14 studies involving 9295 patients were included. The results indicated that low ApoA-I level was significantly associated with poor overall survival (OS) (HR = 0.52, 95% CI: 0.44-0.61). Significant relationships between the ApoA-I level and OS were specifically detected in nasopharyngeal carcinoma (NPC, HR = 0.63, 95% CI: 0.54-0.73), colorectal cancer (CRC, HR = 0.48, 95% CI: 0.19-0.76), and hepatocellular carcinoma (HCC, HR = 0.46, 95% CI: 0.27-0.65). The subgroup analyses for OS also further confirmed the prognostic significance of the ApoA-I level in cancers. Moreover, lower Apo A-I was associated with unfavorable cancer-specific survival (CSS, HR: 0.47, 95% CI: 0.19-0.76) in cancers, and low ApoA-I level was clearly associated with inferior total time to recurrence (TTR, HR: 0.43, 95% CI: 0.29-0.58) in HCC, poorer locoregional recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS) (HR: 0.58, 95% CI: 0.42-0.74 for LRFS; HR: 0.65, 95% CI: 0.41-0.89 for DMFS) in NPC, and shorter disease-free survival (DFS, HR: 0.64, 95% CI: 0.43-0.84) in cancers. Conclusions. Low ApoA-I level might be an unfavorable prognostic factor in multiple malignancies, and serum ApoA-I could serve as a noninvasive marker to predict cancer prognosis.

Maternal Apolipoprotein B100 Serum Levels are Diminished in Pregnancies with Intrauterine Growth Restriction and Differentiate from Controls

PURPOSE

Intrauterine growth restriction, a major cause of fetal morbidity and mortality, is defined as a condition in which the fetus does not reach its genetically given growth potential. Screening for intrauterine growth restriction biomarkers in the mother's blood would be of great help for optimal pregnancy management and timing of delivery as well as for identifying fetuses requiring further surveillance during their infancies.

EXPERIMENTAL DESIGN

A multiplexing serological assay based on liquid chromatography-multiple-reaction-monitoring mass spectrometry is applied for distinguishing serum samples of pregnant women.

RESULTS

Assessment of concentrations of apolipoproteins and of proteins that belong to the lipid transport system is performed with maternal serum samples, consuming only 10 μL of serum per multiplex assay from each patient. Of all investigated proteins the serum concentrations of apolipoprotein B100 shows the greatest power for discriminating intrauterine growth restriction from control samples, reaching areas under curves above 0.85 in receiver-operator-characteristics analyses.

CONCLUSIONS

These results indicate the potential of liquid chromatography-multiple-reaction-monitoring mass spectrometry to become of clinical importance in the future for intrauterine growth restriction risk assessment based on maternal apolipoprotein B100 serum levels.

Apolipoprotein B/apolipoprotein A1 ratio and mortality among incident peritoneal dialysis patients

BACKGROUND

To investigate the association between the ratio of apolipoprotein B (apo B) / apolipoprotein A1 (apo A1) with all-cause mortality and cardiovascular events in peritoneal dialysis (PD) patients.

METHODS

Eight hundred and sixty incident PD patients were enrolled from November 1, 2005, to February 28, 2017, and followed until May 31, 2017. Outcomes were all-cause mortality and cardiovascular events. Associations between the apo B/apo A1 ratio with all-cause mortality and cardiovascular events were evaluated using multivariable-adjusted Cox models.

RESULTS

Of the 860 patients, the mean age was 49.9 ± 14.5 years, 57.6% were men, and 19.3% were diabetic patients. The median apo B/apo A1 ratio was 0.65 (range: 0.22-2.24). During a median follow-up period of 27 months (interquartile range, 13 - 41 months), 202 deaths, and 145 cardiovascular events were recorded. After adjustment for age, sex, body mass index, diabetes, cardiovascular disease, systolic blood pressure, total Kt/V, estimated glomerular filtration rate, hemoglobin level, neutrophil to lymphocyte ratio and albumin, triglyceride, and cholesterol, as well as the use of lipid-lowering agents, the highest apo B/apo A1 ratio tertile was significantly associated with a hazard ratio for all-cause mortality of 1.60 (95% CI: 1.02 to 2.49, P = 0.040) and for cardiovascular events of 2.04 (95% CI: 1.21 to 3.44, P = 0.008).

CONCLUSION

An increased apo B/apo A1 ratio was independently associated with all-cause mortality and cardiovascular events in PD patients.

High density lipoprotein with apolipoprotein C-III is associated with carotid intima-media thickness among generally healthy individuals

BACKGROUND AND AIMS

About 6-7% of high density lipoprotein (HDL) has a protein called apolipoprotein (apo) C-III that regulates lipoprotein metabolism and can provoke an inflammatory response. HDL without apoC-III is inversely associated with coronary heart disease (CHD), whereas HDL with apoC-III is directly associated with CHD. We investigated how the presence of apoC-III affects the association between HDL and early stages of atherosclerosis measured as carotid intima-media thickness (cIMT).

METHODS

We examined the cross-sectional associations between the apoA-I concentrations of HDL subspecies with and without apoC-III and cIMT measured by high resolution B-mode carotid ultrasonography among 847 participants from the European multi-center Relationship between Insulin Sensitivity and Cardiovascular disease (RISC) study.

RESULTS

HDL with and without apoC-III demonstrated significantly opposite associations with both cIMT indexes (p-heterogeneity of associations comparing the two subspecies was 0.002 for cIMT at common carotid artery (cIMT at CCA) and 0.006 for the maximum cIMT in any carotid segment (cIMT max)). Compared to the lowest quintile, the highest quintile of apoA-I in HDL without apoC-III was associated with 3.7% lower cIMT at CCA (p-trend = 0.01) or 7.3% lower cIMT max (p-trend = 0.003), while the highest quintile of apoA-I in HDL with apoC-III was associated with 4.4% higher cIMT at CCA (p-trend = 0.001) or 7.9% higher cIMT max (p-trend = 0.002). Total apoA-I as well as total HDL cholesterol was not associated with cIMT whereas higher levels of total apoC-III and apoC-III contained in HDL were significantly associated with higher cIMT (p-trend<0.01).

CONCLUSIONS

HDL apoC-III is a promising target for atherosclerosis prevention and treatment.