Ye Zixiang, Xie Enmin, Lin Zhangyu, Song Chenxi, Zhang Rui, Wang Haoyu, Zhang Yongbao, Dou Kefei
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
State Key Laboratory of Cardiovascular Disease, Beijing, China.
Nutr J. 2025 Jan 17;24(1):11. doi: 10.1186/s12937-025-01078-9.
This study aims to evaluate the relationship between apolipoproteins (ApoA1, ApoB, and the ApoB/A1 ratio) and the incidence of major adverse cardiovascular events (MACE) in patients with coronary artery disease (CAD) and impaired kidney function, assessing their potential role in secondary prevention.
A prospective cohort of 1,640 patients with impaired kidney function who underwent percutaneous coronary intervention in China was analyzed. Patients were categorized based on the measurements of ApoA1, ApoB, and ApoB/A1 ratio. MACE, defined as a composite of all-cause mortality, cardiovascular death, nonfatal myocardial infarctions, strokes, and unplanned revascularizations, was tracked post-procedure, with statistical analyses including Kaplan-Meier survival curves and Cox regression models to identify associations with apolipoproteins. Subgroup analyses according to kidney function were conducted.
During a median follow-up of 3.1 years, 324 MACE events were observed. Multivariable Cox regression analyses illustrated higher levels of ApoB and the ApoB/A1 ratio were significantly associated with increased MACE incidence (adjusted HR [95%CI] 1.668[1.044-2.666]; adjusted HR [95%CI] 2.231[1.409-3.533], respectively), while lower ApoA1 levels correlated with a higher risk (adjusted HR [95%CI] 0.505[0.326-0.782]). ROC curve analyses indicated comparable predictive performances to traditional risk factors like LDL cholesterol. Subgroup analysis revealed that the above association was not statistically significant in the moderate-to-severe renal impairment CAD patients (eGFR < 45 mL/min/1.73 m).
Our findings illustrate that apolipoproteins, specifically ApoA1 and ApoB, along with their ratio, are significant predictors of major adverse cardiovascular events in CAD patients with impaired kidney function. These results emphasize the need for incorporating apolipoprotein measurements in secondary prevention strategies for this high-risk population.
本研究旨在评估载脂蛋白（载脂蛋白A1、载脂蛋白B及载脂蛋白B/载脂蛋白A1比值）与冠状动脉疾病（CAD）合并肾功能受损患者主要不良心血管事件（MACE）发生率之间的关系，评估它们在二级预防中的潜在作用。
对中国1640例接受经皮冠状动脉介入治疗的肾功能受损患者进行前瞻性队列分析。根据载脂蛋白A1、载脂蛋白B及载脂蛋白B/载脂蛋白A1比值的测量结果对患者进行分类。将MACE定义为全因死亡、心血管死亡、非致命性心肌梗死、中风和计划外血运重建的综合指标，术后对其进行跟踪，统计分析包括Kaplan-Meier生存曲线和Cox回归模型，以确定与载脂蛋白的关联。根据肾功能进行亚组分析。
在中位随访3.1年期间，观察到324例MACE事件。多变量Cox回归分析表明，较高水平的载脂蛋白B及载脂蛋白B/载脂蛋白A1比值与MACE发生率增加显著相关（调整后HR[95%CI]分别为1.668[1.044-2.666]；调整后HR[95%CI]为2.231[1.409-3.533]），而较低的载脂蛋白A1水平与较高风险相关（调整后HR[95%CI]为0.505[0.326-0.782]）。受试者工作特征（ROC）曲线分析表明，其预测性能与低密度脂蛋白胆固醇等传统危险因素相当。亚组分析显示，上述关联在中度至重度肾功能损害的CAD患者（估算肾小球滤过率[eGFR]<45 mL/min/1.73 m²）中无统计学意义。
我们的研究结果表明，载脂蛋白，特别是载脂蛋白A1和载脂蛋白B及其比值，是CAD合并肾功能受损患者主要不良心血管事件的重要预测指标。这些结果强调了在这一高危人群的二级预防策略中纳入载脂蛋白测量的必要性。
