Baseline white blood cell count-to-apolipoprotein A1 ratio as a novel predictor of long-term adverse outcomes in patients who underwent percutaneous coronary intervention: a retrospective cohort study

Abstract

Background: Previous studies suggested that baseline white blood cell count and apolipoprotein A1 levels were associated with clinical outcomes in patients with coronary heart disease (CAD) who underwent percutaneous coronary intervention (PCI). However, the ratio of baseline white blood cell count-to-apolipoprotein A1 level (WAR) and CAD after PCI have not been investigated. The present study investigated the effects of baseline WAR on longterm outcomes after PCI in patients with CAD. Methods: A total of 6050 patients with CAD who underwent PCI were included in the study. Of these, 372 patients were excluded because no baseline white blood cell counts or apolipoprotein A1 (ApoA1) data was available or because of malignancies or other diseases. Finally, 5678 patients were enrolled in the present study and were divided into 3 groups according to WAR value: lower group-WAR< 5.25 (n = 1889); median group-5.25 ≤ WAR≤7.15 (n = 1892); and higher group-WAR≥7.15 (n = 1897). The primary endpoint was long-term mortality, including all-cause mortality (ACM) and cardiac mortality (CM), after PCI. The average follow-up time was 35.9 ± 22.6 months. Results: A total of 293 patients developed ACM, including 85 (4.5%) patients in the lower group, 90 (4.8%) patients in the median group, and 118 (6.2%) patients in the higher group. The risk of ACM, cardiac mortality (CM), major adverse cardiovascular and cerebrovascular events (MACCEs), and major adverse cardiovascular events (MACEs) increased 62.6% (hazard risk [

Low apolipoprotein A1 was associated with increased risk of cancer mortality in patients following percutaneous coronary intervention: A 10‐year follow‐up study

“…Indeed, a number of clinical studies have discovered associations between the reduced levels of serum ApoA1 and increased risk of many types of cancer in general population 45 . Moreover, previous observational studies indicated that patients with cancer or cancer history had increased risk of in‐hospital mortality following PCI 33 and that elevated ratio of white blood cell count to ApoA1 at PCI was associated with all‐cause and cardiac mortalities 46 . However, the long‐term impact of ApoA1/HDL axis regarding cancer mortality in PCI patients has not been previously evaluated.…”

“…45 Moreover, previous observational studies indicated that patients with cancer or cancer history had increased risk of in-hospital mortality following PCI 33 and that elevated ratio of white blood cell count to ApoA1 at PCI was associated with all-cause and cardiac mortalities. 46 However, the long-term impact of ApoA1/HDL axis regarding cancer mortality in PCI patients has not been previously evaluated. Moreover, experimental studies have suggested that ApoA1, rather than total HDL, has anticancer properties which potentially inhibit proliferation or growth of cancer cells, 47 including a study demonstrating reduced transcriptional levels of ApoA1 in hepatocellular carcinoma (HCC) compared to normal liver tissue.…”

Inflammation in coronary artery disease-clinical implications of novel HDL-cholesterol–related inflammatory parameters as predictors

“…Besides, a higher level of WBC is shown to indicate the development of heart failure in patients with stable CAD [ 101 ]. Interestingly, the association between WBC and CAD could be improved and serve as an independent predictor by associating with apoA-I [ 102 ]. Therefore, the WBC to HDL-C ratio (WHR) is utilized to measure the inflammatory status.…”

Association of the MACROD2 rs6110695 A>G polymorphism with an increasing WBC count in a Korean population

“…Due to the rising WBC count and reduced apolipoprotein A‐I, the WBC to apolipoprotein A‐I ratio was significantly increased in the AG genotype group (Table 1). Although the underlying mechanism of lipid profile alterations with the MACROD2 rs6110695 A>G polymorphism cannot be elucidated by our findings, a previous study reported that a high WBC to apolipoprotein A‐I ratio is significantly related to long‐term adverse prognosis in CVD 31 . Similarly, the neutrophil to apolipoprotein A‐I ratio was identified as a novel predictor for overall survival in patients with hepatocellular carcinoma 32 .…”

“…Although the underlying mechanism of lipid profile alterations with the MACROD2 rs6110695 A>G polymorphism cannot be elucidated by our findings, a previous study reported that a high WBC to apolipoprotein A‐I ratio is significantly related to long‐term adverse prognosis in CVD. 31 Similarly, the neutrophil to apolipoprotein A‐I ratio was identified as a novel predictor for overall survival in patients with hepatocellular carcinoma. 32 Maintenance of a high WBC to apolipoprotein A‐I ratio seems to be related to poor prognosis of diseases; hence, having the rs6110695 AG genotype is somewhat unfavorable.…”