Relationships between lipoprotein components and risk of ischaemic and haemorrhagic stroke in the Apolipoprotein MOrtality RISk study (AMORIS)

Abstract

Objectives. To compare lipoprotein components associated with ischaemic and haemorrhagic stroke by age and gender in the Apolipoprotein MOrtality RISk (AMORIS) Study (n = 148 600).Design. Prospective follow-up study (11.8, range 7-17 years) of fatal and nonfatal ischaemic and haemorrhagic stroke through linkage with Swedish hospital discharge and mortality registers.Setting. Measurements of lipoprotein components from health check-ups in the larger Stockholm area.Results. Ischaemic stroke was more common than haemorrhagic stroke (5 : 1), but case fatality was higher in haemorrhagic stroke. An elevated apoB ⁄ apoA-1 ratio and triglycerides, non-HDL cholesterol, low HDL cholesterol, and the total cholesterol to high-density cholesterol (TC ⁄ HDL-C) ratio were associated with increased incidence of nonfatal and fatal ischaemic stroke as well as all cerebrovascular events (n = 7480) in both genders. The associations were somewhat stronger for nonfatal than fatal events. In ischaemic stroke the apoB ⁄ apoA-1 ratio was a stronger predictor than the TC ⁄ HDL-C ratio in all subjects, in those below 65 years of age and in those with LDL-C below 3 mmol L )1 . Haemorrhagic stroke was not associated with elevated atherogenic lipoproteins except for increased risk of fatal haemorrhagic stroke in women with a high apoB ⁄ apoA-I ratio.Conclusions. Dyslipidaemia is associated with an increased risk of ischaemic stroke but few relations were seen in haemorrhagic stroke. Use of the apoB ⁄ apoA-I ratio as a marker of dyslipidaemia is at least as efficient as conventional lipids, for the identification of subjects at increased risk of stroke, especially ischaemic stroke. Practical advantages, fasting is not needed, speak in favour of using apoB and apoA-1 in stroke risk prediction.

The apoB/apoA-I Ratio is a Strong Predictor of Cardiovascular Risk

“…Additional results (55) also favor apoB over LDL-C, and others are also reported in the section on the apo-ratio below. Such major studies are the AMORIS (3,44,56,57). In our study we found the steepest risk-relationship for MI with increasing values of apoB followed by non-HDL-C and the lowest increase in relation to LDL-C values with similar risk progressions for men and women (Figure 2 and Figure 3 left).…”

Triglycerides and Cardiovascular Disease

“…213 In the Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe (DECODE) study, non-HDL-C predicted 10-year CVD mortality only among those with impaired fasting glucose, not among those with normal fasting glucose. 214 Non-HDL-C levels also predicted ischemic stroke, 215,216 and its predictive value has been further demonstrated in both men and women, across all age and ethnic groups, and with or without CVD or associated risk factors. Non-HDL-C can be assessed in the nonfasting state 22,217 and is more accurately determined because it does not depend on fasting triglyceride concentrations, as calculated LDL-C does.…”

“…[203][204][205][206][207][208][209][210][211][212][213][214][215][216] In the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Study, an autopsy study of 15-to 34-year-old individuals who died of non-CVD causes, non-HDL-C was correlated with fatty streaks and raised lesions in the right coronary artery. 204 In adults, non-HDL-C correlates with coronary calcification 205,206 and CVD progression.…”

Risk of prostate cancer is not associated with levels of C‐reactive protein and other commonly used markers of inflammation

“…This linkage of national registers to the CALAB database is called the Apolipoprotein MOrtality RISk (AMORIS) study, and it has been described in detail elsewhere. [15][16][17][18][19][20][21] Our study complied with the Declaration of Helsinki, and the ethics review board of the Karolinska Institute approved the study.…”