Association between Serum Apolipoprotein A1 and Atrial Fibrillation: A Case-Control Study

Background: The relationship between apolipoprotein A1(APOA1) and atrial fibrillation (AF) is not known. Therefore, we sought to investigate the associations between APOA1 and AF by sex in the Chinese population. Methods: This case-control study included 950 patients with AF (29-83 years old, 50.42 % male) who were hospitalized consecutively between January 2019 and September 2021. Controls with sinus rhythm and without AF were matched (1:1) to cases by sex and age. Pearson correlation analysis was performed to investigate the correlation between APOA1 and blood lipid profiles. Multivariate regression models were used to explore the association between APOA1 and AF. Receiver operator characteristic (ROC) curve was constructed to examine the performances of the APOA1. Results: Low APOA1 in male and female patients with AF patients was significantly associated with AF (OR=0.261, 95% CI:0.162-0.422, P＜0.001), regardless of statin use. Pearson correlation analysis indicated serum APOA1 was positively correlated with total cholesterol (TC) (r=0.456, p＜0.001), low-density lipoprotein cholesterol (LDL-C) (r=0.825, p＜0.001), high-density lipoprotein cholesterol (HDL-C) (r=0.238, p＜0.001) , and apolipoprotein B(APOB) (r=0.083, p=0.011). ROC curve analysis showed APOA1 levels=1.105 g/L in men and APOA1 levels=1.205 g/L were the most optimal cut-off values for predicting AF.Conclusion: Low APOA1 in male and female patients is significantly associated with AF in the Chinese population. APOA1 may be a potential biomarker for AF and contribute to the pathological progress of AF along with low blood lipid profiles. The potential mechanisms remain to be further explored.