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

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.