Key result
An elevated apolipoprotein B/A-1 ratio (fifth vs first quintile) was associated with an increased incidence of aortic valve disease (HR 1.28; 95% CI 1.09-1.50), regardless of previous MACE.
Why the study?
Lipoproteins are associated with acquired aortic valve stenosis, but whether an elevated apolipoprotein B/apoA-1 ratio increases the risk of aortic stenosis and is influenced by prior MACE remained unclear.
Does an elevated apolipoprotein B/A-1 ratio increase the risk of incident aortic stenosis in adults?
Cohort (n=131,816)
Does an elevated apolipoprotein B/A-1 ratio increase the risk of incident aortic stenosis in adults?
Hazard Ratio: 1.28 (95% CI 1.09–1.5)
An elevated apolipoprotein B/A-1 ratio is independently associated with an increased risk of incident aortic stenosis, particularly in women and individuals aged ≥65 years.
Should not yet inform aortic valve disease risk assessment; leaves open whether apolipoprotein B/A-1 ratio improves prediction beyond traditional lipids.
BACKGROUND: Lipoproteins are associated with acquired aortic valve stenosis (AS). This study investigated whether an elevated apolipoprotein (apo)B/apoA-1 ratio was associated with an increased risk of AS and if this association was influenced by a history of a major adverse cardiovascular event (MACE) defined as stroke, myocardial infarction or revascularisation. METHODS: A study was undertaken of 131,816 individuals, aged ≥30 years, from the Swedish Apolipoprotein MOrtality RISk (AMORIS) cohort, with measurements of apolipoproteins B and A-1 at health examinations during 1985-1996. RESULTS: There were fewer women and the average age was 4 years older in the highest apoB/apoA-1 quintile compared with the lowest. Being overweight, having reduced renal function and diabetes mellitus were more frequent. Low-density lipoprotein cholesterol, triglyceride and apolipoprotein B levels were higher in the top apoB/apoA-1 quintile. During follow-up through 2011, non-rheumatic aortic valve disease was diagnosed in 2,999 individuals (2.3%). Using ICD-10 codes from 1997, AS was identified in 1,887 patients. An elevated apoB/apoA-1 ratio was associated with an increased incidence of aortic valve disease after multivariable adjustment [hazard ratio (HR) (95% CI) for the fifth vs first quintile of 1.28 (1.09-1.50)]. Restricting the analyses to incident AS during 1997-2011 yielded an HR of 1.41 (1.15-1.72). This increased incidence was primarily seen in women and individuals aged ≥65 years. History of MACE did not influence these associations. CONCLUSIONS: An elevated apoB/apoA-1 ratio was associated with an increased incidence of AS, particularly in women and individuals aged ≥65 years, regardless of previous MACE.
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Ivert et al. (2021) conducted a cohort in Aortic stenosis (n=131,816). Elevated apolipoprotein B/A-1 ratio vs. Lowest apolipoprotein B/A-1 ratio quintile was evaluated on Incidence of aortic valve disease (HR 1.28, 95% CI 1.09-1.50). An elevated apolipoprotein B/A-1 ratio (fifth vs first quintile) was associated with an increased incidence of aortic valve disease (HR 1.28; 95% CI 1.09-1.50), regardless of previous MACE.
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