van Capelleveen Julian C, Bochem Andrea E, Boekholdt S Matthijs, Mora Samia, Hoogeveen Ron C, Ballantyne Christie M, Ridker Paul M, Sun Wensheng, Barter Philip J, Tall Alan R, Zwinderman Aeilko H, Kastelein John J P, Wareham Nick J, Khaw Kay-Tee, Hovingh G Kees
Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands.
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
J Am Heart Assoc. 2017 Aug 3;6(8):e006636. doi: 10.1161/JAHA.117.006636.
The contribution of apolipoprotein A-I (apoA-I) to coronary heart disease (CHD) risk stratification over and above high-density lipoprotein cholesterol (HDL-C) is unclear. We studied the associations between plasma levels of HDL-C and apoA-I, either alone or combined, with risk of CHD events and cardiovascular risk factors among apparently healthy men and women.
HDL-C and apoA-I levels were measured among 17 661 participants of the EPIC (European Prospective Investigation into Cancer)-Norfolk prospective population study. Hazard ratios for CHD events and distributions of risk factors were calculated by quartiles of HDL-C and apoA-I. Results were validated using data from the ARIC (Atherosclerosis Risk in Communities) and WHS (Women's Health Study) cohorts, comprising 15 494 and 27 552 individuals, respectively. In EPIC-Norfolk, both HDL-C and apoA-I quartiles were strongly and inversely associated with CHD risk. Within HDL-C quartiles, higher apoA-I levels were not associated with lower CHD risk; in fact, CHD risk was higher within some HDL-C quartiles. ApoA-I levels were associated with higher levels of CHD risk factors: higher body mass index, HbA1c, non-HDL-C, triglycerides, apolipoprotein B, systolic blood pressure, and C-reactive protein, within fixed HDL-C quartiles. In contrast, HDL-C levels were consistently inversely associated with overall CHD risk and CHD risk factors within apoA-I quartiles (<0.001). These findings were validated in the ARIC and WHS cohorts.
Our findings demonstrate that apoA-I levels do not offer predictive information over and above HDL-C. In fact, within some HDL-C quartiles, higher apoA-I levels were associated with higher risk of CHD events, possibly because of the unexpected higher prevalence of cardiovascular risk factors in association with higher apoA-I levels.
URL: https://www.clinicaltrials.gov. Unique identifier: NCT00000479.
载脂蛋白A-I（apoA-I）在高密度脂蛋白胆固醇（HDL-C）之外对冠心病（CHD）风险分层的贡献尚不清楚。我们研究了明显健康的男性和女性中，单独或联合的HDL-C和apoA-I血浆水平与CHD事件风险及心血管危险因素之间的关联。
在欧洲癌症前瞻性调查（EPIC）-诺福克前瞻性人群研究的17661名参与者中测量了HDL-C和apoA-I水平。通过HDL-C和apoA-I的四分位数计算CHD事件的风险比和危险因素分布。使用社区动脉粥样硬化风险（ARIC）队列和妇女健康研究（WHS）队列的数据分别包含15494人和27552人对结果进行验证。在EPIC-诺福克研究中，HDL-C和apoA-I的四分位数均与CHD风险呈强烈负相关。在HDL-C四分位数范围内，较高的apoA-I水平与较低的CHD风险无关；事实上，在一些HDL-C四分位数中CHD风险更高。在固定的HDL-C四分位数内，apoA-I水平与较高的CHD危险因素水平相关：较高的体重指数、糖化血红蛋白、非HDL-C、甘油三酯、载脂蛋白B、收缩压和C反应蛋白。相比之下，在apoA-I四分位数内（<0.001），HDL-C水平与总体CHD风险和CHD危险因素始终呈负相关。这些发现在ARIC和WHS队列中得到验证。
我们的研究结果表明，apoA-I水平在HDL-C之外并不能提供预测信息。事实上，在一些HDL-C四分位数中，较高的apoA-I水平与较高的CHD事件风险相关，这可能是因为与较高apoA-I水平相关的心血管危险因素意外地更高。
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