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

Abstract

Previous studies showed that elevated apolipoprotein A1 (ApoA1) and high-density lipoprotein cholesterol (HDL-C) predicted reduced risk of cardiovascular-related (CV) mortality in patients following percutaneous coronary intervention (PCI). Nevertheless, as the association between ApoA1 and cancer mortality in this population has been rarely addressed, our study aimed to evaluate prognostic impact of ApoA1 on multiple types of cancer mortality after PCI. This is a retrospective analysis of a single-center prospective registry database of patients who underwent PCI between 2000 and 2018. The present study enrolled 3835 patients whose data of serum ApoA1 were available and they were divided into three groups according to the tertiles of the preprocedural level of ApoA1. The outcome measures were total, gastrointestinal, and lung cancer mortalities. The median and range of the follow-up period between the index PCI and latest follow-up were 5.9 and 0-17.8 years, respectively. Consequently, Kaplan-Meier analyses showed significantly higher rates of the cumulative incidences of total, gastrointestinal, and lung cancer mortality in the lowest ApoA1 tertile group compared to those in the highest. In contrast, there were no significant differences in all types of cancer mortality rates in the groups divided by the tertiles of HDL-C. Multivariable Cox proportional hazard regression analysis adjusted by cancer-related prognostic factors, such as smoking status, identified the elevated ApoA1 as an independent predictor of decreased risk of total and gastrointestinal cancer mortalities. Our study demonstrates the prognostic implication of preprocedural ApoA1 for predicting future risk of cancer mortality in patients undergoing PCI.

Causal association of blood lipids with all-cause and cause-specific mortality risk: a Mendelian randomization study

“…Finally, our study uncovered a novel causal relationship between ApoA1 and cancer mortality. This finding is in line with a previous retrospective study conducted on patients undergoing percutaneous coronary intervention, which showed that lower ApoA1 levels increased the risk of gastrointestinal cancer mortalities ( 30 ). One possible explanation for the protective role of high ApoA1 in cancer mortality is its beneficial properties, including antioxidative and anti-inflammatory capacities, that are linked to improved vascular function ( 31 ).…”

Associations of HDL-C and ApoA-I with Mortality Risk in PCI Patients Across Different hsCRP Levels

“… 8 As for CAD patients undergoing PCI, the only factor linked to a higher risk of cancer mortality was decreased ApoA-I levels. 35 This was the first study to report the relationship between ApoA-I and cardiac death among PCI patients, which was basically in line with the above-mentioned studies, providing evidence of the hazard of low ApoA-I levels.…”

Favorable Effect of High-Density Lipoprotein Cholesterol on Gastric Cancer Mortality by Sex and Treatment Modality

“…In a recent cohort study, all-cause mortality and cancer mortality have an inverse association with HDL-C levels [9]. Low apolipoprotein A1 was associated with an increased risk of cancer mortality in patients who underwent percutaneous coronary intervention [10]. A recent meta-analysis also suggested that HDL-C is associated with mortality from all-cause, cardiovascular disease, and cancer [11].…”