The utility of the apolipoprotein A1 remnant ratio in predicting incidence coronary heart disease in a primary prevention cohort: The Jackson Heart Study.
BACKGROUND
Dyslipidemia plays a significant role in the progression of cardiovascular disease. The apolipoprotein (apo) A1 remnant ratio (apo A1/VLDL3-C + IDL-C) has recently been shown to be a strong predictor of death/myocardial infarction risk among women >50 years undergoing angiography. However, whether this ratio is associated with coronary heart disease risk among other populations is unknown. We evaluated the apo A1 remnant ratio and its components for coronary heart disease incidence.


METHODS
Observational.


METHODS
Participants (N = 4722) of the Jackson Heart Study were evaluated. Baseline clinical characteristics and lipoprotein subfractions (Vertical Auto Profile method) were collected. Cox hazard regression analysis, adjusted by standard cardiovascular risk factors, was utilized to determine associations of lipoproteins with coronary heart disease.


RESULTS
Those with new-onset coronary heart disease were older, diabetic, smokers, had less education, used more lipid-lowering medication, and had a more atherogenic lipoprotein profile. After adjustment, the apo A1 remnant ratio (hazard ratio = 0.67 per 1-SD, p = 0.002) was strongly associated with coronary heart disease incidence. This association appears to be driven by the IDL-C denominator (hazard ratio = 1.23 per 1-SD, p = 0.007). Remnants (hazard ratio = 1.21 per 1-SD, p = 0.017), but not apo A1 (hazard ratio = 0.85 per 1-SD, p = 0.121) or VLDL3-C (hazard ratio = 1.13 per 1-SD, p = 0.120) were associated with coronary heart disease. Standard lipids were not associated with coronary heart disease incidence.


CONCLUSIONS
We found the apo A1 remnant ratio to be strongly associated with coronary heart disease. This ratio appears to better stratify risk than standard lipids, apo A1, and remnants among a primary prevention cohort of African Americans. Its utility requires further study as a lipoprotein management target for risk reduction.
Intermountain Medical Center, Murray, USA heidi.may@imail.org.
Heidi T
HT
May
UCSF, Fresno, USA.
John R
JR
Nelson
University of Mississippi Medical Center, Jackson, USA.
Seth T
ST
Lirette
Atherotech, Birmingham, USA.
Krishnaji R
KR
Kulkarni
Intermountain Medical Center, Murray, USA University of Utah, Salt Lake City, USA.
Jeffrey L
JL
Anderson
University of Mississippi Medical Center, Jackson, USA.
Michael E
ME
Griswold
Intermountain Medical Center, Murray, USA University of Utah, Salt Lake City, USA.
Benjamin D
BD
Horne
University of Mississippi Medical Center, Jackson, USA.
Adolfo
A
Correa
Intermountain Medical Center, Murray, USA University of Utah, Salt Lake City, USA.
Joseph B
JB
Muhlestein
D000328:Adult; D001741:Black or African American; D017677:Age Distribution; D000368:Aged; D016632:Apolipoprotein A-I / Q000097:blood*; D003324:Coronary Artery Disease / Q000097:blood / Q000208:ethnology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D013997:Time Factors; D014481:United States / Q000453:epidemiology
C505693:APOA1 protein, human; D016632:Apolipoprotein A-I
Lipids; apolipoproteins; gender; outcomes; lipoprotein ratios; lipoprotein subfractions; remnant lipoproteins; risk