Key result
Higher atherogenic index of plasma linked to ~55% higher CVD mortality per 0.1-unit increase.
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Why the study?
The association between the atherogenic index of plasma and cardiovascular mortality, particularly in young adults, those with LDL-C <100 mg/dL, and individuals with diabetes, was unclear.
Does higher average atherogenic index of plasma (AIP) predict increased cardiovascular mortality in adults without prior cardiovascular disease?
Cohort (n=8,922,312)
Yes
Does higher average atherogenic index of plasma (AIP) predict increased cardiovascular mortality in adults without prior cardiovascular disease?
Elevated atherogenic index of plasma is independently associated with increased long-term cardiovascular mortality, providing potential incremental value for residual risk stratification even in patients with well-controlled LDL-C.
BACKGROUND AND AIMS: To evaluate the association between the atherogenic index of plasma (AIP) and cardiovascular disease (CVD) mortality, with a particular focus on young adults, individuals with low-density lipoprotein cholesterol (LDL-C) <100 mg/dL, and those with established diabetes. METHODS: We analyzed data from 8922312 adults without prior CVD or cancer in the Korean National Health Insurance Service database (2011-2012). Average AIP, calculated from repeated measurements as the base-10 logarithm of the triglyceride-to-high-density lipoprotein cholesterol ratio, was used as the exposure. The primary outcome was CVD mortality, including deaths from ischaemic heart disease (IHD), acute myocardial infarction (AMI), haemorrhagic stroke, ischaemic stroke, and heart failure. RESULTS: During a mean follow-up of 11.7 years, 83220 CVD deaths occurred. Among adults aged 18-44 years, each 0.1-unit increase in AIP was associated with higher CVD mortality in both men (hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.29-1.86) and women (HR 3.00, 95% CI 1.85-4.85; both P < 0.001). Higher AIP was also independently associated with increased CVD mortality among individuals with LDL-C <100 mg/dL (HR 1.48, 95% CI 1.41-1.54) and those with diabetes (HR 2.33, 95% CI 2.18-2.48; both P < 0.001). Similar associations were consistently observed across these subgroups for IHD- and AMI-related mortality. CONCLUSIONS: Elevated AIP was independently associated with increased CVD mortality, even among young adults, individuals with well-controlled LDL-C, and those with diabetes. AIP may provide incremental value for residual cardiovascular risk stratification in primary prevention.
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Kang et al. (2026) conducted a cohort in Cardiovascular disease (n=8,922,312). Average atherogenic index of plasma (AIP) was evaluated on CVD mortality, including deaths from ischaemic heart disease, acute myocardial infarction, haemorrhagic stroke, ischaemic stroke, and heart failure (HR 1.55, 95% CI 1.29-1.86, p=<0.001). Each 0.1-unit increase in the atherogenic index of plasma was associated with increased CVD mortality in young men (HR 1.55, 95% CI 1.29-1.86) and women (HR 3.00, 95% CI 1.85-4.85).
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