Association between the atherogenic index of plasma and major adverse cardiovascular events among non-diabetic hypertensive older adults

Remnant cholesterol is superior to other lipid-related parameters for the prediction of cardiometabolic disease risk in individuals with hypertension: The Kailuan study

BACKGROUND

It is uncertain which lipid-related parameter is most suitable for predicting the risk of cardiometabolic disease (CMD) in individuals with hypertension.

AIMS

To explore which lipid-related parameter is most suitable for predicting the risk of CMD.

METHODS AND RESULTS

We studied 30,378 patients with hypertension who completed the 2006-2007 Kailuan health examination and followed up until December 31, 2021. In the constructed model, the utilities of lipid-related parameters for the prediction of CMD were compared using the C-index, NRI, and IDI. The best predictor (remnant cholesterol, RC) was identified and the participants were grouped according to RC quartile. Cox proportional hazard analysis was then used to evaluate the relationship between RC and the risk of CMD. During a median follow-up period of 14.7 years (IQR 5.3-15.1), 9502 (31.27 %) participants with hypertension developed CMD. The C-index, NRI, and IDI values for RC were higher than those for the other lipid parameters. After adjustment for multiple potential confounding factors, compared with the quartile (Q)1 RC group, the adjusted hazard ratios for CMD of the Q2-Q4 groups were 1.09 (1.03-1.16), 1.17 (1.11-1.24), and 1.25 (1.18-1.33) (P < 0.0001). Restrictive cubic spline analysis revealed dose-dependent relationships of lipid parameters with the risk of CMD.

CONCLUSIONS

RC is superior to other lipid parameters for the prediction of the risk of CMD in individuals with hypertension. As the concentration of RC increases, the risk of CMD in such individuals also increases.

Lipoprotein(a) as a novel biomarker for predicting adverse outcomes in ischemic heart failure

Background

Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD). However, the association between Lp(a) and adverse outcomes in patients with ischemic heart failure (IHF) remains unclear. This study aimed to investigate the relationship between serum Lp(a) levels and the incidence of major adverse cardiovascular events (MACE) in IHF patients.

Methods

In this single-center, retrospective cohort study, 1,168 IHF patients who underwent elective percutaneous coronary intervention (PCI) were enrolled. Patients were divided into four groups based on Lp(a) quartiles. The primary endpoint was MACE, defined as a composite of all-cause mortality, non-fatal myocardial infarction (MI), and any revascularization. Cox proportional hazards models were used to evaluate the association between Lp(a) quartiles and adverse outcomes. Restricted cubic spline (RCS) curve were constructed to explore the nonlinear relationship between Lp(a) levels and MACE risk. Subgroup analyses were performed to investigate the association in different subgroups.

Results

The incidence of MACE increased significantly across Lp(a) quartiles (Quartile 4 vs. Quartile 1: 46.4% vs. 22.9%, P < 0.001). After adjusting for confounding factors, the highest Lp(a) group remained independently associated with an increased risk of MACE (HR, 95% CI: 2.28, 1.69-3.07, P < 0.001, P for trend <0.001), all-cause mortality (HR, 95% CI: 2.33, 1.54-3.54, P < 0.001, P for trend = 0.01), and any revascularization (HR, 95% CI: 2.18, 1.35-3.53, P = 0.002, P for trend = 0.001). The RCS model demonstrated a nonlinear positive relationship between Lp(a) levels and MACE risk. Subgroup analysis revealed a significant interaction with body mass index (BMI), with a more pronounced association observed in patients with higher BMI (P for interaction <0.001).

Conclusion

Elevated Lp(a) levels were independently associated with an increased risk of MACE, mortality, and revascularization in IHF patients, with a stronger effect in obese individuals.

Association between atherogenic index of plasma and all-cause mortality and specific-mortality: a nationwide population‑based cohort study

BACKGROUND

Atherogenic index of plasma (AIP), a marker of atherosclerosis and cardiovascular disease (CVD). However, few studies have investigated association between AIP and all-cause mortality and specific-mortality in the general population.

METHODS

This study included data from 14,063 American adults. The exposure variable was the AIP, which was defined as log10 (triglycerides/high-density lipoprotein cholesterol). The outcome variables included all-cause mortality and specific-mortality. Survey-weighted cox regressions were performed to evaluate the relation between AIP and all-cause mortality and specific-mortality. Weighted restricted cubic spline was conducted to examin the non-linear relationship.

RESULTS

During 10 years of follow-up, we documented 2,077, 262, 854, and 476 cases of all-cause mortality, diabetes mortality, CVD mortality and cancer mortality, respectively. After adjustment for potential confounders, we found that atherogenic index of plasma (AIP) was significantly associated with an increased risk of diabetes mortality when comparing the highest to the lowest quantile of AIP in female (p for trend = 0.001) or participants older than 65 years (p for trend = 0.002). AIP was not significantly associated with all-cause mortality, CVD mortality and cancer mortality (p > 0.05). Moreover, a non-linear association was observed between AIP and all-cause mortality in a U-shape (p for non-linear = 0.0011), while a linear relationship was observed with diabetes mortality and non-diabetes mortality (p for linear < 0.0001).

CONCLUSIONS

In this study, there is a no significant association between high AIP levels and a high risk of all-cause and cardiovascular mortality. Besides, a higher AIP was significantly associated with an increased risk of diabetes mortality, which only found in women older than 65 years. AIP was associated with all-cause mortality in a U-shape. This association could be explained by the finding that higher AIP predicted a higher risk of death from diabetes, and that lower AIP predicted a higher risk of death from non-diabetes causes.

The correlation of atherogenic index of plasma with non-obstructive CAD and unfavorable prognosis among patients diagnosed with MINOCA

BACKGROUND

The atherogenic index of plasma (AIP) is linked to lipid metabolism and has shown considerable prognostic value in cardiovascular disorders. However, its role in myocardial infarction with non-obstructive coronary arteries (MINOCA) has not been investigated. We assessed the relationship between AIP, the severity of coronary stenosis, and prognosis in MINOCA.

METHODS

We included consecutive patients who were diagnosed with MINOCA. AIP was calculated using the base 10 logarithm of the ratio between the levels of TG and HDL-C. The patients were divided into four groups based on their AIP quartiles: Q1 (AIP<-0.145), Q2 (AIP≥-0.145and≤0.049), Q3 (AIP>0.049and≤0.253), and Q4 (AIP>0.253). All patients underwent follow-up for MACE.

RESULTS

The final analysis included 421 patients, with 188 having normal coronaries (0 stenosis) and 233 exhibiting non-obstructive coronary artery disease (CAD) (<50 % stenosis). In the multivariate logistic analysis, highest AIP (Q4) group was significantly associated with increased risk of non-obstructive CAD in MINOCA (OR,1.994;95 % CI:1.075-3.698; P = 0.029). During the follow-up period, MACE occurred in 22.8 % of MINOCA patients. Q4 group exhibited a significantly higher rate of MACE (P = 0.021). Furthermore, when both AIP and coronary stenosis status were considered, the results revealed individuals in the Q4 group with non-obstructive CAD had the highest risk of MACE (log-rank P = 0.027). The adjusted Cox analysis indicated that the Q4 group was associated with a 2.052-fold increase in the HR of MACE.

CONCLUSION

AIP exhibits a notable association with the incidence of MACE in MINOCA patients and serves as a substantial marker for non-obstructive CAD in this patient group.

The association of atherogenic index of plasma with cardiovascular outcomes in patients with coronary artery disease: A systematic review and meta-analysis

BACKGROUND

Atherogenic index of plasma (AIP) represents a novel marker in the current era of cardiovascular diseases. In this meta-analysis, we aimed to evaluate the association of AIP with cardiovascular prognosis in patients with coronary artery disease (CAD).

METHODS

PubMed, Scopus, and Web of Science databases were searched from inception through 2024. The primary outcome was major cardiovascular events (MACE). The secondary outcomes included all-causes death, cardiovascular death, myocardial infarction (MI), stroke, revascularization, and no-reflow phenomenon. AIP was determined by taking the logarithm of the ratio of triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C). The data analysis was represented using the risk ratio (RR) along with a 95% confidence interval (CI).

RESULTS

Sixteen studies with a total number of 20,833 patients met the eligible criteria. The pooled-analysis showed a significant increased risk of MACE in the highest AIP group compared with the lowest AIP group (RR = 1.63; 95% CI, 1.44-1.85; P < 0.001). A similar result was observed when AIP was regarded as a continuous variable (RR = 1.54; 95% CI, 1.30-1.83; P < 0.001). Besides, elevated AIP was associated with increased risk of cardiovascular death (RR = 1.79; 95% CI, 1.09-2.78; P = 0.02), MI (RR = 2.21; 95% CI, 1.55-3.13; P < 0.001), revascularization (RR = 1.62; 95% CI, 1.34-1.97; P < 0.001), no-reflow phenomenon (RR = 3.12 95% CI, 1.09-8.96; P = 0.034), and stent thrombosis (RR = 13.46; 95%CI, 1.39-129.02; P = 0.025). However, AIP was not significantly associated with the risk of all-causes death and stroke among patients with CAD.

CONCLUSIONS

The results of this study demonstrated that increased AIP is an independent prognostic factors in patients with CAD. Further research is warranted to elucidate the potential development of targeted interventions to modify AIP levels and improve patient outcomes.

Elevated atherogenic index of plasma increased the risk of myocardial infarction in a general population

PURPOSE

The atherogenic index of plasma (AIP) has been shown to be related to cardiovascular disease risk, but evidence on the longitudinal pattern of AIP during follow-up is limited. We aimed to explore the associations of baseline and long-term AIP with the risk of myocardial infarction (MI).

METHODS

We included 98,861 participants in the Kailuan Study who were free of MI at baseline. AIP was calculated as log (triglyceride/high-density lipoprotein cholesterol). Long-term AIP included the long-term mean AIP (mean AIP from baseline to the first occurrence of MI or the end of follow-up) and number of visits with high AIP (above the cutoff value at the first three visits). The baseline and updated mean AIP were in operationalized as quartiles. Cox proportional hazard models were used to determine the associations between AIP and risk of MI. We excluding all deaths during the follow-up visits in the sensitivity analysis.

RESULTS

During a median follow-up of 12.80 years, 1804 participants developed MI. Compared with quartile 1, the adjusted hazard ratios in baseline and updated mean AIP quartile 4 were 1.63 (95% CI, 1.41-1.88) and 1.59 (95% CI, 1.37-1.83), respectively. Compared with participants who did not have a high AIP, the HR among individuals with AIP elevated by three times was 1.94 (95% CI,1.55-2.45). The sensitivity analysis showed similar associations.

CONCLUSIONS

Elevated levels of both baseline and long-term AIP increased the risk of MI.

Association Between Atherogenic Index of Plasma and Risk of Incident Major Adverse Cardiovascular Events

It is unclear whether the atherogenic index of plasma (AIP) is associated with major adverse cardiovascular events (MACEs) in the general population. A total of 361,644 participants (aged 56.19 ± 8.09 years; 44.79% male) free of a history of MACEs at baseline from the UK Biobank data were included in the analysis. The AIP was calculated using log (triglyceride/high-density lipoprotein-cholesterol). Over a mean follow-up of 12.19 ± 1.60 years, 16,683 participants developed MACEs. After adjustment for traditional risk factors, each 1 unit increase in AIP was associated with a 45.3% higher risk of incident MACEs (hazard ratio (HR), 1.453 [95% confidence interval (CI) 1.371-1.540], P < 0.001). Results were similar when individuals were categorized by the AIP quartiles (HR, 1.283 [95% CI 1.217-1.351]; comparing extreme quartiles). The subgroup analyses showed that the association between AIP and risk of incident MACEs was more obvious in female participants who are < 60 years old and free of hypertension or diabetes. Sensitivity analysis included participants without any lipid-lowering medication or excluded incident MACEs in the first 2 years of follow-up confirming the robustness of the findings. Elevated AIP is a risk factor of incident MACEs in the general population, independent of traditional risk factors.Dynamic monitoring of the AIP may help select the population at high risk of cardiovascular events and guide primary prevention.

Relationship between the cumulative exposure to atherogenic index of plasma and ischemic stroke: a retrospective cohort study

BACKGROUND

Atherogenic index of plasma (AIP) has been demonstrated as a surrogate marker for ischemic stroke, but there is limited evidence for the effect of long-term elevation of AIP on ischemic stroke. Therefore, we aimed to characterize the relationship between cumulative exposure to AIP and the risk of ischemic stroke.

METHODS

A total of 54,123 participants in the Kailuan Study who attended consecutive health examinations in 2006, 2008, and 2010 and had no history of ischemic stroke or cancer were included. The time-weighted cumulative AIP (cumAIP) was calculated as a weighted sum of the mean AIP values for each time interval and then normalized to the total duration of exposure (2006-2010). Participants were divided into four groups according to quartile of cumAIP: the Q1 group, ≤-0.50; Q2 group, - 0.50 to - 0.12; Q3 group, - 0.12 to 0.28; and Q4 group, ≥ 0.28. Cox proportional hazard models were used to evaluate the relationship between cumAIP and ischemic stroke by calculating hazard ratios (HRs) and 95% confidence intervals (95% CIs).

RESULTS

After a median follow-up of 11.03 years, a total of 2,742 new ischemic stroke events occurred. The risk of ischemic stroke increased with increasing quartile of cumAIP. After adjustment for potential confounders, Cox regression models showed that participants in the Q2, Q3, and Q4 groups had significantly higher risks of ischemic stroke than those in the Q1 group. The HRs (95% CIs) for ischemic stroke in the Q2, Q3, and Q4 groups were 1.17 (1.03, 1.32), 1.33 (1.18, 1.50), and 1.45 (1.28, 1.64), respectively. The longer duration of high AIP exposure was significantly associated with increased ischemic stroke risk.

CONCLUSIONS

High cumulative AIP is associated with a higher risk of ischemic stroke, which implies that the long-term monitoring and maintenance of an appropriate AIP may help prevent such events.

Association between cumulative atherogenic index of plasma exposure and risk of myocardial infarction in the general population

BACKGROUND

Atherogenic index of plasma (AIP) has been confirmed as a novel marker for myocardial infarction (MI), but few evidence on the long-term AIP and MI risk in general populations. We thus aimed to evaluate the relationships of cumulative exposure to AIP and its accumulation time course with the risk of MI.

METHODS

A total of 54,440 participants were enrolled in the Kailuan study. Time-weighted cumulative AIP was calculated as the weighted sum of the mean AIP value for each time interval, then normalized by total exposure duration, the exposure duration was from 2006 to 2010. Duration of high AIP exposure was defined as the duration with high AIP and ranged from 0 to 6 years. The time course of AIP accumulation was categorized by the combination of time-weighted cumulative AIP < or ≥ median (- 0.12) and AIP slope.

RESULTS

After 11.05 years of follow-up, 766 incident MI cases were documented. After adjustment for potential confounders, higher risk of MI was observed in participants with the highest time-weighted cumulative AIP quartile (HR, 1.89; 95% CI 1.47-2.43), the longest exposure duration of high AIP (HR, 1.52; 95% CI 1.18-1.95), and those with high time-weighted cumulative AIP and negative slope (HR, 1.42; 95% CI 1.13-1.79).

CONCLUSIONS

Long-term cumulative exposure to AIP and the time course of AIP accumulation increased the risk of MI. High AIP earlier resulted in a greater risk increase than later in life with the same time-weighted cumulative AIP, emphasizing the importance of controlling atherogenic dyslipidemia early in life.