title: A new ratio for better predicting future death/myocardial infarction than standard lipid measurements in women >50 years undergoing coronary angiography: the apolipoprotein A1 remnant ratio (Apo A1/ [VLDL₃+IDL]).
abstract: BACKGROUND
  Women often lag behind men in their risk of cardiovascular events. However, with age and the onset of menopause, women's cardiovascular risk eventually becomes similar to that of men. This change in risk may, in part, be attributable to a shift to a more atherogenic lipid profile. Our objective was to evaluate standard- and sub-lipid parameters and the apo A1 remnant ratio: (apo A1/[VLDL₃-C+IDL-C]) for their associations with death/myocardial infarction among peri- and post-menopausal women.
  
  
  METHODS
  Women (N=711) >50 years of age undergoing coronary angiography were evaluated. Baseline clinical and angiographic characteristics, lipids, and sub-lipid levels (Vertical Auto Profile method) were collected. Cox regression analysis, adjusted by standard cardiovascular risk factors, was utilized to determine associations of lipid and sub-lipid tertiles(T) with death/myocardial infarction at 1 and 3 years.
  
  
  RESULTS
  Patients averaged 67.7±9.4 years and 53.6% had underlying severe (≥70% stenosis) coronary artery disease. The apo A1 remnant ratio was found to have stronger associations for 1 year (T1 vs. T3: HR=2.13, p=0.03, T2 vs. T3: HR=1.57, p=0.21) and 3 year (T1 vs. T3: HR=2.32, p=0.002, T2 vs. T3: HR=1.97, p=0.01) death/myocardial infarction than any individual lipid (LDL-C, HDL-C, triglycerides, non-HDL-C) or sub-lipid (apo A1, apo B, VLDL₃-C+IDL-C) measure, or any other well-known ratio (triglyercies/HDL-C, apo B/A1, TChol/HDL-C, HDL-C/[VLDL₃-C+IDL-C]).
  
  
  CONCLUSIONS
  The apo A1 remnant ratio was a significant predictor of short and intermediate-term death/myocardial infarction risk among women >50 years of age. Furthermore, this ratio was found to have greater predictive ability than traditional lipid and sub-lipid parameters and represents a potential new risk marker.
authors.affiliation: Intermountain Medical Center, Cardiovascular Department, 5121 S. Cottonwood Street, Murray, UT 84157, USA. heidi.may@imail.org
authors.forename: Heidi T
authors.initials: HT
authors.lastname: May
authors.forename: John R
authors.initials: JR
authors.lastname: Nelson
authors.forename: Krishnaji R
authors.initials: KR
authors.lastname: Kulkarni
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Anderson
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Horne
authors.forename: Tami L
authors.initials: TL
authors.lastname: Bair
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Muhlestein
mesh_terms: D000368:Aged; D016632:Apolipoprotein A-I / Q000097:blood*; D002784:Cholesterol / Q000097:blood*; D008076:Cholesterol, HDL / Q000097:blood; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008074:Lipoproteins / Q000097:blood*; D008079:Lipoproteins, VLDL / Q000097:blood*; D008297:Male; D008593:Menopause; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D017698:Postmenopause; D011379:Prognosis; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood
chemical_list: D016632:Apolipoprotein A-I; D008076:Cholesterol, HDL; D008074:Lipoproteins; D008079:Lipoproteins, VLDL; D014280:Triglycerides; C030104:lipoprotein cholesterol; D002784:Cholesterol