An increased high-density lipoprotein cholesterol/apolipoprotein A-I ratio is associated with increased cardiovascular and all-cause mortality

Sung, K.C., Ryu, S., Wild, S.H. and Byrne, Christopher D. (2015) An increased high-density lipoprotein cholesterol/apolipoprotein A-I ratio is associated with increased cardiovascular and all-cause mortality. Heart, 101 (7), 553-558. (doi:10.1136/heartjnl-2014-306784). (PMID:25637367)

Abstract

Objective: high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A-I (Apo A-I) are key cardiovascular risk factors, but whether the ratio of HDL-C/Apo A-I concentrations affects risk of cardiovascular disease (CVD) and other diseases is uncertain. To investigate whether HDL-C and Apo A-I concentrations and the ratio of HDL-C/Apo A-I affect risk of death from CVD, cancer and all causes.

Design, setting and patients: data were analysed from an occupational cohort of 263?340 people between 2002 and 2009. Cox proportional hazards models were used to estimate HRs (and 95% CIs) for mortality using the sex-specific lowest quartiles of HDL-C, Apo A-I concentrations and HDL-C/Apo A-I ratio as the reference groups.

Main outcome measures: 1012 participants died (median follow-up 4.2?years). There were no significant associations between HDL quartiles and all mortality outcomes. In contrast, there was a positive trend for the association across increasing HDL/Apo A-I ratio quartiles and mortality from CVD, cancer and all cause (p values for trends across quartiles=0.016, 0.001 and <0.001, respectively). The adjusted HRs for highest HDL/Apo A-I ratio quartile versus the lowest were 2.37 (95% CI 0.89 to 6.37) (CVD); 2.32 (95% CI 1.34 to 4.03) (cancer) and 1.87 (95% CI 1.32 to 2.66) (all-cause mortality).

Conclusions: these data show for the first time that an increased HDL-C/Apo A-I ratio may be a shared risk factor for CVD, cancer and all-cause mortality

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Contributors

Author: Christopher D. Byrne

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