Inflammatory markers, lipoprotein components and risk of major cardiovascular events in 65,005 men and women in the Apolipoprotein MOrtality RISk study (AMORIS)

Abstract

Background and aims In contrast to lipoprotein components, few studies have analysed the importance of a combination of commonly available inflammatory markers as predictors of major cardiovascular events (MACE) in large healthy populations . We examined summary scores of inflammation and compared their predictive strength with that of lipoproteins in the Apolipoprotein MOrtality RISk (AMORIS) Study. Method and results Using data from AMORIS and the Swedish hospital discharge and mortality registers, a prospective cohort study of 65,050 subjects with mean follow-up time of 11.8 years, we studied the association between lipoproteins, inflammatory markers and risk of acute myocardial infarction (AMI), stroke and heart failure. An inflammatory score was measured as the number of inflammatory variables (white blood cell count, haptoglobin and in a subgroup CRP) in their upper quartile or as a continuous summary score. All analyses were conducted with multivariate Cox proportional hazards analysis. The inflammatory scores added predictive information over and above classical lipids such as total cholesterol and triglycerides. Compared to the apolipoprotein B (apoB)/apolipoprotein A-1 (apoA-1) ratio, a stronger marker of CVD risk than conventional lipids, the inflammatory score added some discrimination value measured by net reclassification improvement, but added more within higher risk strata. No statistically significant biological interaction was found between lipoproteins and inflammatory markers. Conclusion The inflammation score and lipoproteins, including apoB and apoA-I, carry important and at least additive predictive information for risk of MACE. Routinely used markers of inflammation could be used in daily medical practice to assess cardiovascular risk.