Association of apolipoprotein levels with all-cause and cardiovascular mortality

Jiarong Zhang; Xinru Song; Zhi Li; Haibo Xu; Haotian Shu; Jun Li; Yan Zhang

doi:10.1093/eurjpc/zwae080

Association of apolipoprotein levels with all-cause and cardiovascular mortality

Eur J Prev Cardiol. 2024 Feb 28:zwae080. doi: 10.1093/eurjpc/zwae080. Online ahead of print.

Authors

Jiarong Zhang¹, Xinru Song², Zhi Li¹, Haibo Xu¹, Haotian Shu¹, Jun Li², Yan Zhang¹

Affiliations

¹ School of Public Health, Nanjing Medical University, Nanjing, China.
² Department of General Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China.

PMID: 38417834
DOI: 10.1093/eurjpc/zwae080

Abstract

Aims: Research has shown that apolipoproteins (Apos) are potential indicators of heart health and death. We investigated the associations of apolipoprotein levels with all-cause and cardiovascular mortality.

Methods: We systematically searched the Cochrane Library, PubMed and Web of Science for English-language studies up to November 28, 2022. We used Stata 17.0 to summarize the estimated effects with 95% confidence intervals (CIs). We also conducted subgroup analyses according to study location, year of publication, individual age, follow-up years, and sample size. Moreover, we performed a sensitivity analysis to evaluate bias in our study.

Results: This study included 23 studies with 152854 individuals in total. The level of ApoA was negatively related to cardiovascular mortality (OR = 0.69, 95% CI = 0.52-0.93). An increased ratio of ApoB/A1 was a risk factor for cardiovascular mortality (OR = 2.13, 95% CI = 1.48-3.07) and all-cause mortality (OR = 2.05, 95% CI = 1.52-2.77). The level of ApoB was positively related to cardiovascular mortality (OR = 1.12, 95% CI = 0.85-1.47), but the difference was not statistically significant. However, the associations between ApoB or ApoA1 and all-cause mortality were not obvious. Our subgroup analysis showed that the location, year of publication, individual age, and follow-up years of the studies affected the heterogeneity of our study to varying degrees. The sensitivity analysis showed that our results were almost robust, apart from excluding the article by Nomikos (OR = 0.77, 95% CI = 0.65-0.92) and Zeng (OR = 0.77, 95% CI = 0.65-0.91), when investigating the relationship between ApoA1 and all-cause mortality.

Conclusion: In this study, we found that apolipoprotein levels were linked to cardiovascular and all-cause mortality. Our study strengthens the evidence on the association between the level of apolipoproteins and cardiac health and may provide ideas for regulating the level of apolipoproteins to promote public health.

Keywords: apolipoproteins; cardiovascular disease; mortality; risk factor.

Plain language summary

This study supports the association between apolipoproteins and cardiac health by conducting an analysis of the impact of ApoA1, ApoB2 and the ratio of ApoB/A1 on cardiovascular mortality and all-cause mortality. These findings may provide some ideas for promoting public health.