Apolipoproteins A1, B, and apoB/apoA1 ratio are associated with first ST-segment elevation myocardial infarction but not with recurrent events during long-term follow-up

Mathijs C Bodde,Frits R Rosendaal,Willem M Lijfering,Fred P H T M Romijn,L Renee Ruhaak,Christa M Cobbaert,Maaike P J Hermans,Martin J Schalij,J Wouter Jukema,Arnoud Van Der Laarse

doi:10.1007/s00392-018-1381-5

Abstract

IntroductionThe current way to assess the risk of cardiovascular disease (CVD) is to measure conventional lipid and lipoprotein cholesterol fractions. Despite the success of statin treatment, residual cardiovascular risk remains high. Therefore, the value of extensive serum apolipoprotein (apo) profiling to assess the risk of ST-segment elevation myocardial infarction (STEMI) and of major adverse cardiac events (MACE) in patients with STEMI was investigated in a case–control design.Methods and resultsSerum apo levels were measured using liquid chromatography and mass spectrometry in 299 healthy individuals and 220 patients with STEMI. First, the association of apo profiles in baseline samples with risk of STEMI was examined, and second, the association of apo profiles at baseline with risk of recurrent MACE in patients with STEMI in a longitudinal study design was studied. High baseline (> 1.25 g/L) apoA1 levels were associated with a decreased risk of STEMI [odds ratio (OR) 0.17; 95% CI 0.11–0.26], whereas high apoB (> 1.00 g/L) levels (OR 2.17; 95% CI 1.40–3.36) and apoB/apoA1 ratio (OR per 1 SD (OR/SD): 2.16; 95% CI 1.76–2.65) were associated with an increased risk. Very-low-density-lipoprotein (VLDL)-associated apos gave conflicting results. Neither conventional lipid levels nor apo levels were associated with MACE in the STEMI group.ConclusionIn conclusion, apoA1, apoB, and apoB/apoA1 were strongly associated with risk of STEMI. No clear relation between VLDL-associated apos and the risk of STEMI was found. Neither baseline serum apos nor lipids predicted MACE in statin-treated patients during long-term follow-up after a first STEMI.

Highlights

The current way to assess the risk of cardiovascular disease (CVD) is to measure conventional lipid and lipoprotein cholesterol fractions
Whereas total cholesterol (TC) and LDLc levels did not differ between the two groups, HDLc was significantly lower and TG and remnant cholesterol were significantly higher in the segment elevation myocardial infarction (STEMI) group
ApoA1 was significantly lower in the STEMI group than in the control group (1.24 ± 0.24 g/L versus 1.53 ± 0.31 g/L, respectively, p < 0.001) and apoB was significantly higher in the STEMI group than in the control group (1.18 ± 0.25 g/L versus 1.08 ± 0.29 g/L, respectively, p < 0.001)

Summary

Introduction

The current way to assess the risk of cardiovascular disease (CVD) is to measure conventional lipid and lipoprotein cholesterol fractions. The value of extensive serum apolipoprotein (apo) profiling to assess the risk of ST-segment elevation myocardial infarction (STEMI) and of major adverse cardiac events (MACE) in patients with STEMI was investigated in a case–control design. Pechlaner et al presented in the Bruneck study new data about the relation of very-lowdensity-lipoprotein (VLDL)-associated apos, i.e., apoCII, apoCIII, and apoE, with incident CVD. As residual cardiovascular risk remains high [8] even after successful treatment of traditional risk factors, a case–control study with long-term follow-up of patients with STEMI was executed to evaluate the value of extensive serum apo profiling for (1) prediction of STEMI and for (2) prediction of recurrent major adverse cardiac events (MACE) in patients with STEMI. A previously developed method for quantitative serum apo profiling using liquid chromatography (LC) and mass spectrometry (MS), which has proven to be highly accurate and in concordance with quality requirements for medical tests, independent of the presence of hypertriglyceridemia, was used [19]

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