Apoprotein B/Apoprotein A-1 Ratio and Mortality among Prevalent Dialysis Patients

Abstract

Background and objectives In dialysis patients, the associations between apoprotein profile and all-cause or cardiovascular disease (CVD)-related mortality are not well known. We, therefore, investigated whether apoprotein levels are associated with these events.Design, setting, participants, & measurements We undertook a prospective observational cohort study of prevalent hemodialysis patients aged $18 years (n=1081), who were followed for 4 years (2011)(2012)(2013)(2014). Outcomes were all-cause and CVD-related mortality. Predictors used were baseline apoprotein levels, particularly the apoprotein B (apo B)/ apoprotein A-1 (apo A-1) ratio. A Cox regression analysis was used to calculate the hazard ratios (HRs) for mortality. Apo A-1, apo B, and apo B/ apo A-1 ratio were analyzed with adjustments in three models: model 1, basic adjustment for age and sex; model 2, basic adjustments plus dialysis conditions (dialysis vintage, mean predialysis systolic blood pressure, dry weight, and mean intradialytic weight gain); and model 3, model 2 plus metabolic and inflammatory conditions (basal kidney disease, serum albumin, C-reactive protein level, and statin use).Results Of the 1081 patients included in the study, 203 deaths were recorded, 92 of which were related to CVD. The apo B/ apo A-1 ratio was significantly associated with all-cause and CVD-related mortality when analyzed by 1-SD increments or quartile IV versus I in all models. In model 3, HRs and 95% confidence intervals (95% CIs) for 1-SD increments of apo B/ apo A-1 ratio for all-cause mortality or CVD-related mortality were: HR, 1.16 (95% CI, 1.00 to 1.35), or HR, 1.38 (95% CI, 1.11 to 1.71), respectively, and for quartile IV versus I: HR, 1.65 (95% CI, 1.05 to 2.57), or HR, 2.56 (95% CI, 1.21 to 5.40), respectively. Apo A-1 was significantly associated with both mortalities in models 1 and 2. However, apo B was only significantly associated with CVD-related mortality in model 3.Conclusions Apoprotein measurement, especially the apo B/ apo A-1 ratio, was significantly associated with allcause and CVD-related mortality in prevalent dialysis patients.

Association of Lead aVR T‐wave Amplitude With Cardiovascular Events or Mortality Among Prevalent Dialysis Patients

“…The cause of death was reported by the attending physicians. Definitions of stroke, acute MI, congestive heart failure, and sudden death have also been reported in detail in our previous report .…”

“…Methods of collecting clinical data, events, and deaths have been detailed in our previous report . Briefly, clinical data were collected from questionnaires recorded by attending physicians.…”

Apolipoproteins A and B and PCSK9: Nontraditional Cardiovascular Risk Factors in Chronic Kidney Disease and in End-Stage Renal Disease

“…ApoA-I was significantly associated with all-cause mortality and cardiovascular mortality in HD patients [26] and PD patients [25]. In CKD patients, Cerezo et al revealed that high ApoA-I concentrations have been significantly associated with the development of new cardiovascular episodes and were negatively associated with mortality (but with a lower level of significance) [21].…”

“…ApoB is a marker of dyslipidemia and is important in the binding of LDL particles to LDLR (receptor of LDL) for cellular absorption and degradation of LDL par-ticles [11]. Apolipoprotein B (ApoB) is the primary protein component of very low-density lipoproteins (VLDL), intermediate-density lipoprotein (IDL), and LDL-C [11,25,26] and reflects the atherogenic particles from the body [11,25,26]. Other roles of ApoB are displayed in Figure 4 [36].…”

Expressão gênica de ApoA1 e ApoB em de frangos de corte de duas linhagens diferentes

“…A relação entre ApoB/ApoA1 é importante para o adequado transporte lipídico (Barter e Kastelein, 2006), dado que ApoA1 está presente em partículas potencialmente antiaterogênicas e ApoB em partículas aterogênicas. Sato et al (2016) avaliaram a correlação entre ApoA1, ApoB e potencial aterogênico e antiaterogênico e observaram que Apo A-1 foi significativamente correlacionado com HDL (r = 0,86) e apo B foi significativamente correlacionada com LDL, colesterol não HDL e a relação LDL / HDL (r = 0,86, 0,93 e 0,64, respectivamente) evidenciando a necessidade da manutenção das relações adequadas entre ApoB e ApoA1. O valor numérico da relação ApoB/ApoA1 varia de acordo com a espécie (Tabela 3).…”