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Apolipoprotein B/apolipoprotein A1 ratio and non-high-density lipoprotein cholesterol

Predictive value for CHD severity and prognostic utility in CHD patients

Verhältnis von Apolipoprotein B zu Apolipoprotein A1 und Nicht-HDL-Cholesterin

Prädiktiver Wert für den Schweregrad der KHK und prognostischer Nutzen bei KHK-Patienten

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Abstract

Background and aims

To explore the clinical value of the combination of apolipoprotein B/apolipoprotein A1 (apoB/A1) and non-high-density lipoprotein cholesterol (HDL-C) in evaluating the severity of coronary heart disease (CHD) and in predicting in-hospital CHD events and the long-term prognosis of CHD patients.

Methods

According to the results of coronary angiography, 826 patients were enrolled and classified into a CHD group (532 cases, including single-branch stenosis group, n = 165; double-branch stenosis group, n = 175;and multi-branch stenosis group, n = 192) and a normal group (294 cases). The serum apoB/apoA1 ratio and non-HDL-C were calculated at baseline. The Gensini score and logistic regression were applied to analyze the association between the apoB/apoA1 ratio, non-HDL-C, and the severity of CHD. Major in-hospital adverse incidents were recorded and follow-up telephone interviews were conducted 3 years after discharge.

Results

Both the apoB/apoA1 ratio and non-HDL-C rose with the number of stenotic coronary branches. Only apoB and apoB/apoA1 remained significantly associated with the risk of multi-branches lesions and the Gensini score after adjustment. Patients with combined high levels of apoB/apoA1 and non-HDL-C (N = 50, 43.10 %) suffered from the highest risk of multi-branches lesions. Similarly, patients with combined high levels of apoB/apoA1 and non-HDL-C not only suffered from the highest risk of in-hospital new-onset heart failure and cardiac death (16.38 % vs. 10.35 %), but also had the highest risk of adverse events, angina, myocardial infarction, new-onset heart failure, stroke, and cardiac death after an average 3-year follow-up.

Conclusion

The combination of apoB/apoA1 and non-HDL-C is predictive of the severity of CHD, and it could provide more prognostic information than its individual components or other routine lipid profiles.

Zusammenfassung

Hintergrund und Ziel

Untersucht werden sollte der klinische Nutzen einer Kombination aus dem Verhältnis von Apolipoprotein B zu Apolipoprotein A1 (ApoB/A1) und jenem Cholesterin, welches nicht zur High-density-Lipoprotein-Kategorie gehört, also Nicht-HDL-Cholesterin, bei der Ermittlung des Schweregrads einer koronaren Herzkrankheit (KHK) und bei der Abschätzung von KHK-Ereignissen während stationärer Behandlung sowie der Langzeitprognose von KHK-Patienten.

Methoden

Den Ergebnissen der Koronarangiographie entsprechend wurden 826 Patienten in die Studie aufgenommen und in eine KHK-Gruppe eingestuft (532 Fälle, einschließlich der Gruppe mit Einzelaststenose, n = 165; Doppelaststenose, n = 175; und Mehraststenose, n = 192), außerdem gab es eine normale Gruppe (294 Fälle). Die Serum-ApoB/ApoA1-Ratio und Nicht-HDL-Cholesterin wurden zu Beginn berechnet. Für den Zusammenhang zwischen ApoB/ApoA1-Ratio, Nicht-HDL-Cholesterin und KHK-Schweregrad wurden der Gensini-Score und die logistische Regression eingesetzt. Schwere unerwünschte Ereignisse während stationärer Behandlung wurden dokumentiert und 3 Jahre lang nach Entlassung über Telefonbefragungen nachverfolgt.

Ergebnisse

Sowohl die ApoB/ApoA1-Ratio als auch das Nicht-HDL-Cholesterin stiegen mit der Anzahl stenotischer Koronaräste. Nach Adjustierung blieben nur ApoB und die ApoB/ApoA1-Ratio signifikant mit dem Risiko von Mehrastläsionen und dem Gensini-Score verknüpft. Bei Patienten mit hohen Werten für die ApoB/ApoA1-Ratio und Nicht-HDL-Cholesterin (n = 50; 43,10 %) bestand das höchste Risiko für Mehrastläsionen. In ähnlicher Weise ergab sich für Patienten mit hohen Werten für die ApoB/ApoA1-Ratio und Nicht-HDL-Cholesterin nicht nur das höchste Risiko einer neu auftretenden Herzinsuffizienz und eines Herztods während des stationären Aufenthalts (16,38 vs. 10,35 %), sondern auch das höchste Risiko unerwünschter Ereignisse, wie Angina, Herzinfarkt, neu auftretende Herzinsuffizienz, Schlaganfall und Herztod, nach einem Follow-up von durchschnittlich 3 Jahren.

Schlussfolgerung

Die Kombination der ApoB/ApoA1-Ratio und des Nicht-HDL-Cholesterin-Werts ist ein Prädiktor für den Schweregrad der KHK und könnte mehr prognostische Informationen liefern als ihre einzelnen Komponenten oder andere Routinelipidprofile.

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Acknowledgments

This work was supported by the National Natural Science Foundation of China (81370331), Shanghai Municipal Science and Technology Commission (12140903402), and Young Medical Talents Training Program of Shanghai Municipal Health Bureau (XYQ2011011) to Z.Y. Chen, and the Shanghai Municipal Science and Technology Commission (10JC1410502) to G.P. Lu.

Compliance with ethical guidelines

Conflict of interest. P. Liting, L. Guoping, and C. Zhenyue state that there are no conflicts of interest. The accompanying manuscript does not include studies on humans or animals.

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Authors and Affiliations

  1. Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, No.197, Ruijin 2nd Road, Shanghai, China

    P. Liting, L. Guoping & C. Zhenyue

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  1. P. Liting
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  2. L. Guoping
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  3. C. Zhenyue
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Correspondence to C. Zhenyue.

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Liting, P., Guoping, L. & Zhenyue, C. Apolipoprotein B/apolipoprotein A1 ratio and non-high-density lipoprotein cholesterol. Herz 40 (Suppl 1), 1–7 (2015). https://doi.org/10.1007/s00059-014-4147-5

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  • DOI: https://doi.org/10.1007/s00059-014-4147-5

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