What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertension (n=20013). Intervention: Elevated-increasing atherogenic index of plasma (AIP) trajectory vs. Low-stable atherogenic index of plasma (AIP) trajectory. Primary outcome: Incident cardiovascular disease (first occurrence of myocardial infarction, ischemic stroke, or hemorrhagic stroke) (HR 1.43, 95% CI 1.14-1.79, p=0.001).

What question did this study set out to answer?

To investigate the long-term trajectory of the atherogenic index of plasma (AIP) and its association with cardiovascular disease risk in hypertensive individuals.

June 12, 2026Cardiovascular Diabetology – Endocrinology Reports0 citationsOpen Access

Association between the atherogenic index of plasma trajectory and risk of cardiovascular diseases among hypertensive patients: a prospective cohort study

WWWeiqiang WuShantou University P(Peng Fu (417962)Shantou University ZCZefeng CaiShantou University

Key Result

An elevated-increasing atherogenic index of plasma trajectory was associated with a 43% higher risk of incident cardiovascular disease (HR 1.43) compared to a low-stable trajectory in hypertensive patients.

Key Points

To investigate the long-term trajectory of the atherogenic index of plasma (AIP) and its association with cardiovascular disease risk in hypertensive individuals.
Longitudinal cohort study of 20,013 hypertensive participants (mean age: 56.8 years) from the Kailuan cohort in China.
AIP trajectories were modeled using latent mixture modeling over the period from 2006-2010.
Cox proportional hazards models assessed associations between AIP trajectories and incident cardiovascular disease from 2010-2020.
Four distinct AIP trajectories were identified, with the elevated-increasing group showing a 43% higher CVD risk (HR = 1.43, 95% CI: 1.14–1.79; P-trend = 0.001) compared to the low-stable group.
Participants under 45 years with rising AIP showed a 3.4-fold higher CVD risk (HR = 3.40, 95% CI: 1.03–11.16).
Significantly elevated risks were found for myocardial infarction (HR = 1.80; P-trend < 0.001) and ischemic stroke (HR = 1.40; P-trend = 0.001), with no association observed for hemorrhagic stroke (P-trend = 0.734).

Study Design

Type

Cohort (n=20,013)

Multicenter

Yes

Structured PICO

Does an elevated-increasing atherogenic index of plasma (AIP) trajectory increase the risk of incident cardiovascular disease in hypertensive patients?

Population

20,013 Chinese adults with hypertension, free of prior cardiovascular disease or cancer, followed for a median of 11.9 years.

Exposure

Elevated-increasing atherogenic index of plasma (AIP) trajectory (AIP range: 1.12 to 1.46) over a 4-year exposure period (2006-2010)

Comparator

Low-stable AIP trajectory group (AIP range: -0.84 to -0.72)

Outcome

Incident CVD, defined as the first occurrence of myocardial infarction, ischemic stroke, or hemorrhagic strokecomposite

Sustained elevation in atherogenic index of plasma (AIP) trajectories is independently associated with a significantly higher risk of incident cardiovascular disease in hypertensive patients.

Main Result

Hazard Ratio: 1.43 (95% CI 1.14–1.79)

Absolute Event Rate: 13.79% vs 9.23%

p-value: p=0.001

Limitations

Residual confounding may persist despite multivariate adjustments.
Cohort was predominantly northern Chinese with a higher proportion of males, limiting generalizability to other demographics.
Could not effectively distinguish participants with primary hypertension from those with secondary hypertension.
Trajectory classification is data-driven and may not fully capture the biological complexity of individual lipid metabolism variations.
Observational design could not establish causal inferences.

Abstract

Abstract Background Cardiovascular disease (CVD) remains the leading cause of global mortality, with hypertension and dyslipidemia synergistically exacerbating the atherogenic risk. The atherogenic index of plasma (AIP), calculated as log (triglycerides/HDL-C), reflects lipid-driven atherosclerosis; however, evidence of long-term AIP trajectory patterns and their cardiovascular implications in hypertensive populations remains scarce. Methods This longitudinal study included 20,013 hypertensive participants (mean age: 56.8 ± 11.0 years; 81.9% male) from the Kailuan cohort, China. The AIP trajectories (2006–2010) were modeled using latent mixture modeling. Cox proportional hazards models were used to assess associations between AIP trajectories and incident CVD (2010–2020), adjusting for demographics, comorbidities, and medications. Results Four distinct AIP trajectories were identified: Low-stable group ( n = 2,920; AIP range: -0.84 to -0.72), Moderate low-stable group ( n = 11,121; AIP range: -0.14 to -0.10), Moderate high-stable group ( n = 5,067; AIP range: 0.42 to 0.53), Elevated-increasing group ( n = 905; AIP range: 1.12 to 1.46). Over a median of 11.9 (interquartile range 11.3–12.3) years of follow-up, 2,332 CVD events occurred. Compared with the low-stable group, participants in the elevated-increasing trajectory exhibited a 43% higher CVD risk (HR = 1.43, 95% CI:1.14–1.79; P -trend = 0.001), with significantly elevated risks of myocardial infarction (HR = 1.80, 1.09–2.51; P -trend < 0.001) and ischemic stroke (HR = 1.40, 1.08–1.80; P -trend = 0.001). Young hypertensives (< 45 years) with rising AIP trajectories demonstrated a 3.4-fold higher CVD risk (HR = 3.40, 1.03–11.16), whereas no associations were observed for hemorrhagic stroke ( P -trend = 0.734). Conclusions Sustained elevation in AIP trajectories is associated with a higher risk of CVD in individuals with hypertension. Sustained maintenance of optimal AIP levels through regular monitoring, combined with blood pressure control and antihypertensive medication adherence, may reduce the CVD risk in hypertensive populations.

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