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Apolipoproteins in the discrimination of atherosclerotic burden and cardiac function in patients with stable coronary artery disease
Author(s) -
Patel Jeetesh V.,
Abraheem Abraheem,
Creamer John,
Gunning Mark,
Hughes Elizabeth A.,
Lip Gregory Y.H.
Publication year - 2010
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfp202
Subject(s) - medicine , cardiology , coronary artery disease , heart failure , disease
Aims To compare the performance of apolipoproteins (Apo) and oxidized LDL against routine clinical lipid profiles in the discrimination of atherosclerotic burden and cardiac function in stable coronary artery disease (CAD) patients. Methods and results Using a cross‐sectional approach, we measured oxidized LDL, Apo AI and B in 199 patients (34–81 years) with stable symptomatic CAD. The discrimination of (i) atherosclerotic burden (coronary atheroma scores, the number of diseased coronary vessels), and (ii) cardiac function [NYHA classification, left‐ventricular systolic dysfunction (LVSD)] were judged using receiver operating characteristic (ROC) curves. The ratio of Apo AI to B was correlated to oxidized LDL (Spearman, r = 0.37, P < 0.001); however, oxidized LDL was unrelated to measures of cardiac function or CAD severity. Concentrations of Apo AI decreased from 1.38 to 1.20 g/L with increasing atheroma scores ( P = 0.02), while triglyceride levels increased from 1.50 to 2.23 mmol/L ( P = 0.016). High‐density lipoprotein (HDL) cholesterol and Apo AI levels were higher among those with heart failure ( P = 0.002), and increased ordinally with NYHA class ( P = 0.005). On ROC analysis, reduced levels of Apo AI and HDL cholesterol were discriminators for patients in the upper quartile for atheroma score ( P < 0.004). Raised indices of HDL were associated with heart failure ( P < 0.002). Conclusion Apo AI levels are a consistent discriminator of atherosclerotic burden among patients with stable CAD. However, heart failure presents an element of confounding in the diagnostic and prognostic utility of Apo monitoring among these patients.