Ratio of Apolipoprotein A-II/B Improves Risk Prediction of Postoperative Survival After Carotid Endarterectomy

Abstract

Background and Purpose— Even in patients with high-grade carotid stenosis, cardiovascular morbidity causes more deaths than strokes do. Despite successful low-density lipoprotein (LDL) cholesterol lowering, a significant risk of atherosclerotic cardiovascular disease remains, eventually rendering other lipid or lipoprotein ratios more efficient treatment targets. This study aimed to investigate the predictive value of the ratio of serum apolipoprotein A-II/B for overall mortality (primary outcome) of carotid surgery patients. Methods— This single-center, nonrandomized, prospective cohort study comprised 327 consecutive patients undergoing carotid endarterectomy for high-grade internal carotid artery stenosis. Baseline lipoprotein concentrations were measured, and patients were observed for the occurrence of the primary outcome until the census date (January, 2003 to January, 2012; median follow-up, 102.3 months). Results— The ratio of apolipoprotein A-II/B (hazard ratio, 0.74 per SD; confidence interval, 0.60–0.91; P =0.004) showed the highest association with the primary outcome compared with other lipid-risk parameters, significantly improving a prognostic model based on major cardiovascular risk factors, including LDL, high-density lipoprotein, and triglycerides in terms of overall performance, calibration, and discrimination. This led to a significantly improved reclassification of 8.9% of all patients (net reclassification improvement, 0.137; P =0.006 and integrated discrimination improvement, 0.041; P <0.001) and of 13.6% of patients with a serum baseline concentration of <100 mg/dL LDL (net reclassification improvement, 0.270; P =0.030 and integrated discrimination improvement, 0.061; P =0.002). Conclusions— Apolipoprotein A-II/B significantly improves risk prediction of overall survival, also in carotid surgery patients with lower LDL levels. Consequently, this ratio might provide an efficient diagnostic tool and eventually a treatment target for actual lipid-lowering therapies, which has to be addressed in future randomized controlled trials.

The impact of frailty on functional survival in patients 1 year after cardiac surgery

“…The magnitude of these improvements is consistent with well-known risk factors for morbidity and mortality in other prediction models, for example, cardiac markers such as troponin T improving the prediction of cardiovascular disease. [30][31][32] The Modified Fried and SPPB frailty definitions generated consistent prevalence rates of frailty in our population (ie, Modified Fried: 49.5%, SPPB: 52.6%) and provided incremental value in identifying individuals at risk of poor 1-year functional survival. Both the SPPB and the MFC were superior in improving the predictive ability of the euroSCORE II compared with the CFS.…”

Apolipoprotein B/AI ratio as an independent risk factor for intracranial atherosclerotic stenosis

“…ApoB was generally regarded as a marker of oxidative and atherogenic properties and the degradation of plasmatic LDL-c could prevent advanced atherosclerotic lesion progression [18]. The ratio of apoB/AI best reflects the status of cholesterol transport to and from peripheral tissues [19]. Overdose lipid would deposit under the endangium of arteries [17, 20].…”

Apolipoprotein A-II, a Player in Multiple Processes and Diseases

“…The ratio of apoA-II/apoB was identified as a better prognostic parameter for lipoprotein-associated risk of postoperative mortality, as compared with the established lipid-risk parameters in patients with high-grade carotid stenosis; therefore, apoA-II/apoB ratio was proposed as an additional risk-prediction tool [ 91 ]. Although structural and functional differences between HDL particles with and without apoA-II (LpA-I: A-II and LpA-I) have not been fully distinguished, LpA-I particles are considered to be more responsible for the anti-atherogenic properties of HDL and LpA-I: A-II particles represents rather an atherogenic indicator [ 92 ].…”