Li Luohua, Zhao Jinhan, Yuan Mei, Jiang Hongying
Department of Nephrology, The Second Hospital Affiliated to Kunming Medical University, Kunming, China.
Department of Nephrology, Jiujiang City Key Laboratory of Cell Therapy, Jiujiang No. 1 People's Hospital, Jiujiang, China.
Front Med (Lausanne). 2025 May 30;12:1575657. doi: 10.3389/fmed.2025.1575657. eCollection 2025.
The atherosclerosis index (AIP) in plasma is a novel indicator closely associated with various metabolic abnormalities, and the bidirectional relationship between metabolic dysfunction and chronic kidney disease (CKD) has been extensively documented. However, evidence regarding the association between AIP and mortality in CKD population remains scarce. This study aims to elucidate the association between baseline AIP levels and both all-cause and specific mortality in a diverse cohort of US adults.
This cohort study utilized data from the National Health and Nutrition Examination Survey (NHANES) spanning from 1999 to 2018. A total of 4,403 participants were included in the analysis. Mortality rates were determined through linkage with the National Death Index (NDI), with follow-up extending through December 31, 2019. The primary outcome variables were all-cause mortality and cause-specific mortality. Multivariable weighted Cox proportional hazards regression models, restricted cubic spline analysis, subgroup stratification, and sensitivity testing were utilized to evaluate the associations between the AIP and both all-cause and cause-specific mortality.
During a median follow-up of 83 months, 1,767 all-cause deaths and 526 CVD deaths occurred. After multivariable adjustment, AIP was independently associated with elevated risks of all-cause mortality (HR: 2.03, 95% CI: 1.62∼2.55, < 0.001) and cardiovascular mortality (SHR: 1.60, 95% CI: 1.08∼2.39, = 0.028). Restricted cubic spline analysis confirmed a linear dose-response relationship between AIP and all-cause mortality ( for non-linearity = 0.243). Subgroup analyses confirmed consistent associations across demographics and comorbidities, with significant interactions observed for sex, BMI, and diabetes ( < 0.05). Sensitivity analyses excluding deaths within 2 years showed similar outcomes (all-cause mortality HR: 1.94, 95% CI: 1.53∼2.47, < 0.001; CVD mortality SHR: 1.69, 95% CI: 1.13∼2.53, = 0.01).
Data from large cohort studies have revealed a significant positive correlation between AIP levels and the risks of all-cause and cardiovascular mortality in the adult population of the United States. This suggests that AIP is associated with an increased risk of adverse outcomes in CKD and may serve as biomarker.
血浆中的动脉粥样硬化指数（AIP）是一种与各种代谢异常密切相关的新型指标，代谢功能障碍与慢性肾脏病（CKD）之间的双向关系已有大量文献记载。然而，关于AIP与CKD人群死亡率之间关联的证据仍然稀少。本研究旨在阐明美国成年人不同队列中基线AIP水平与全因死亡率和特定死亡率之间的关联。
这项队列研究利用了1999年至2018年美国国家健康与营养检查调查（NHANES）的数据。共有4403名参与者纳入分析。通过与国家死亡指数（NDI）联动确定死亡率，随访至2019年12月31日。主要结局变量为全因死亡率和特定病因死亡率。采用多变量加权Cox比例风险回归模型、限制性立方样条分析、亚组分层和敏感性检验来评估AIP与全因死亡率和特定病因死亡率之间的关联。
在中位随访83个月期间，发生了1767例全因死亡和526例心血管疾病死亡。多变量调整后，AIP与全因死亡率升高风险独立相关（HR：2.03，95%CI：1.62～2.55，P<0.001）和心血管死亡率相关（SHR：1.60，95%CI：1.08～2.39，P = 0.028）。限制性立方样条分析证实AIP与全因死亡率之间存在线性剂量反应关系（非线性检验P = 0.243）。亚组分析证实了不同人口统计学和合并症之间的一致关联，在性别、BMI和糖尿病方面观察到显著交互作用（P<0.05）。排除2年内死亡的敏感性分析显示了相似结果（全因死亡率HR：1.94，95%CI：1.53～2.47，P<0.001；心血管疾病死亡率SHR：1.69，95%CI：1.13～2.53，P = 0.01）。
大型队列研究数据显示，美国成年人群中AIP水平与全因死亡率和心血管死亡率风险之间存在显著正相关。这表明AIP与CKD不良结局风险增加相关，可能作为一种生物标志物。
