ApoB/apoA-1 ratio tied to aortic stenosis risk

An elevated ratio between apolipoproteins B to A-1 (apoB/apoA-1) correlates with a higher incidence of aortic stenosis (AS) regardless of previous major adverse cardiovascular events (MACE), especially in the elderly and in women, a recent study has found.

Drawing from the Swedish Apolipoprotein Mortality Risk cohort, the researchers enrolled 131,816 individuals (aged ≥30 years, 42.8 percent women) who had available measurements for apoB and apoA-1. Participants were then grouped into quintiles of apoB/apoA-1.

Over a mean follow-up of 18 years, 2,999 patients developed aortic valve disease. The overall resulting incidence rate was 2.3 percent, which increased from 1.2 percent in the lowest apoB/apoA-1 quintile to 3.2 percent in the highest. Follow-up times in each quintile were comparable.

Cox proportional hazards analysis found that increasing apoB/apoA-1 significantly correlated with higher risk of aortic valve disease (fifth vs first quintile: hazard ratio [HR], 1.64. 95 percent confidence interval [CI], 1.44–1.88). The effect was attenuated but remained significant after additional adjustments for dyslipidaemia. Stratifying by sex showed that the interaction was significant only in women.

Similarly, after multivariable adjustment, an elevated apoB/apoA-1 emerged as a significant indicator of AS risk in both women (HR, 1.46, 95 percent CI, 1.22–1.76) and men (HR, 1.17, 95 percent CI, 1.00–1.38) aged >65 years. MACE history had no clear impact on these interactions.

“Patients with a high apoB/apoA-1 ratio should also have surveillance for potential aortic valve disease. Apolipoprotein levels should be measured in patients with cardiovascular disease. Treatment of dyslipidaemia may reduce the risk of developing AS,” the researchers said.