Association between atherogenic index of plasma and in-hospital mortality in patients with STEMI undergoing primary percutaneous coronary intervention

Year 2023, , 158 - 164, 12.01.2023

Hacı Ahmet Kasapkara , Mehmet Erdoğan

https://doi.org/10.32322/jhsm.1218420

Abstract

Aim: Dyslipidemia is an established risk factor for cardiovascular disease. Increased triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) levels, and decreased high lipoprotein cholesterol (HDL-C) levels were associated with increased cardiovascular risk. Recently, comprehensive lipid profile indices derived from these conventional parameters have attracted to attention. Atherogenic index of plasma (AIP) is one of the indices calculated as the logarithm of TG/HDL-C levels and it is accepted as an alternative and simple marker of plasma atherogenicity. Although various studies demonstrated that their relationship with these lipid indices and clinical outcomes in patients with acute coronary syndrome, this situation is not yet clear in acute ST-elevation myocardial infarction (STEMI) patients undergoing primer percutaneous coronary intervention (pPCI). In this study, we aimed to investigate the relationship of AIP with early mortality in STEMI patients undergoing pPCI.
Material and Method: This is a retrospective, single center, hospital-based study carried out between January 2019 and April 2021. A total of 873 consecutive STEMI patients (705 men; median age 59 years), whose undergoing pPCI, were enrolled. The patients were divided into two groups according to in-hospital mortality status namely survivors vs non-survivors. Conventional lipid values were measured and non-traditional lipid indexes including non-HDL-C [Total cholesterol minus HDL-C], Total cholesterol/HDL-C, LDL-C/HDL-C, atherogenic index (AI) [non-HDL-C/HDL-C], lipoprotein combine index (LCI) [Total cholesterol*TG*LDL-C/HDL-C] and atherogenic index of plasma (AIP) [Log(TG/HDL-C)] were calculated. Angiographic images of the patients were evaluated through the hospital automation system.
Results: AIP was significantly higher in non-survivors compared to survivor group (0.59, 0.47, p=0.006, respectively). AI, non-HDL-C, Total cholesterol/HDL-C ratio, LDL-C/HDL-C ratio and LCI measurements were similar between two groups. The cut-off value of the AIP (0.50) was associated with 70% sensitivity and 52% specificity for predicts in-hospital mortality. Multivariate logistic regression model indicated AIP (OR: 3.77, 95% CI: 1.34–10.6, p < 0.012) as independent predictor of in-hospital mortality in STEMI patients undergoing pPCI.
Conclusion: AIP predicts in-hospital mortality in patients with STEMI undergoing pPCI. AIP, which can be calculated easily by complete blood can be beneficial in evaluating the prognosis of these patients.

Keywords

Atherogenic index of plasma, acute myocardial infarction, dyslipidemia

Project Number

yok

References

• Cherepanov D, Bentley TGK, Hsiao W, et al. Real-world cardiovascular disease burden in patients with atherosclerotic cardiovascular disease: a comprehensive systematic literature review. Curr Med Res Opin 2018; 34: 459-73.
• Roy S. Atherosclerotic Cardiovascular Disease Risk and Evidence-based management of cholesterol. N Am J Med Sci 2014; 6: 191-8.
• Zhu Y, Chen M, Liu K, et al. Atherogenic index of plasma and the risk of in-stent restenosis in patients with acute coronary syndrome beyond the traditional risk factors. J Atheroscler Thromb 2022; 29: 1226-35.
• Lambert M. ACC/AHA release updated guideline on the treatment of blood cholesterol to reduce ASCVD risk. Am Fam Physician 2014; 90: 260-5
• Benjamin EJ, Muntner P, Alonso A, et al. American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation 2019; 139: e56-e528.
• Fernández-Macías JC, Ochoa-Martínez AC, Varela-Silva JA, Pérez-Maldonado IN. Atherogenic index of plasma: novel predictive biomarker for cardiovascular illnesses. Arch Med Res 2019; 50: 285-94.
• Peng J, Luo F, Ruan G, Peng R, Li X. Hypertriglyceridemia and atherosclerosis. Lipids Health Dis 2017; 16: 233.
• Ochoa-Martínez ÁC, Ruíz-Vera T, Pruneda-Álvarez LG, et al. Serum adipocyte-fatty acid binding protein (FABP4) levels in women from Mexico exposed to polycyclic aromatic hydrocarbons (PAHs). Environ Sci Pollut Res Int 2017; 24: 1862-70.
• Buddhari W, Uerojanaungkul P, Sriratanasathavorn C, et al. Low-density lipoprotein cholesterol target attainment in patients surviving an acute coronary syndrome in Thailand: Results From the Dyslipidaemia International Study (DYSIS) II. Heart Lung Circ 2020; 29: 405-13.
• Zhang X, Patel A, Horibe H, et al. Cholesterol, coronary heart disease, and stroke in the Asia Pacific region. Int J Epidemiol 2003; 32: 563-72.
• Zhu X, Yu L, Zhou H, et al. Atherogenic index of plasma is a novel and better biomarker associated with obesity: a population-based cross-sectional study in China. Lipids Health Dis 2018; 17: 37.
• Song P, Xu L, Xu J, et al. Atherogenic ındex of plasma is associated with body fat level in type 2 diabetes mellitus patients. Curr Vasc Pharmacol 2018; 16: 589-95.
• Edwards MK, Blaha MJ, Loprinzi PD. Atherogenic ındex of plasma and triglyceride/high-density lipoprotein cholesterol ratio predict mortality risk better than ındividual cholesterol risk factors, among an older adult population. Mayo Clin Proc 2017; 92: 680-1.
• Collet JP, Thiele H, Barbato E, et al 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021; 42: 1289-367.
• Ibanez B, James S, Agewall S, et al 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39: 119-77.
• Cai G, Shi G, Xue S, Lu W. The atherogenic index of plasma is a strong and independent predictor for coronary artery disease in the Chinese Han population. Medicine (Baltimore) 2017; 96: e8058.
• Bendzala M, Sabaka P, Caprnda M, et al. Atherogenic index of plasma is positively associated with the risk of all-cause death in elderly women: a10-year follow-up. Wien Klin Wochenschr 2017; 129: 793-8.
• Frohlich J, Dobiásová M. Fractional esterification rate of cholesterol and ratio of triglycerides to HDL-cholesterol are powerful predictors of positive findings on coronary angiography. Clin Chem 2003; 49: 1873-80.
• Amsterdam EA, Wenger NK, Brindis RG, et al 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130: 2354-94.
• Ammirati E, Moroni F, Norata GD, Magnoni M, Camici PG. Markers of inflammation associated with plaque progression and instability in patients with carotid atherosclerosis. Mediators Inflamm 2015; 2015: 718329.
• Dobiášová M. Atherogenic impact of lecithin-cholesterol acyltransferase and its relation to cholesterol esterification rate in HDL (FER(HDL)) and AIP [log(TG/HDL-C)] biomarkers: the butterfly effect? Physiol Res 2017; 66: 193-203.
• Petursson H, Sigurdsson JA, Bengtsson C, Nilsen TI, Getz L. Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospective data from the Norwegian HUNT 2 study. J Eval Clin Pract 2012; 18: 159-68.
• Tuikkala P, Hartikainen S, Korhonen MJ, et al. Serum total cholesterol levels and all-cause mortality in a home-dwelling elderly population: a six-year follow-up. Scand J Prim Health Care 2010; 28: 121-7.
• Al-Mallah MH, Hatahet H, Cavalcante JL, Khanal S. Low admission LDL-cholesterol is associated with increased 3-year all-cause mortality in patients with non ST segment elevation myocardial infarction. Cardiol J 2009; 16: 227-33.
• Prospective Studies Collaboration, Lewington S, Whitlock G, et al. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet 2007; 1; 370: 1829-39.
• Onat A, Can G, Kaya H, Hergenç G. "Atherogenic index of plasma" (log10 triglyceride/high-density lipoprotein-cholesterol) predicts high blood pressure, diabetes, and vascular events. J Clin Lipidol 2010; 4: 89-98.
• Cai G, Liu W, Lv S, et al. Gender-specific associations between atherogenic index of plasma and the presence and severity of acute coronary syndrome in very young adults: a hospital-based observational study. Lipids Health Dis 2019; 18: 1-9.
• Qin Z, Zhou K, Li Y, et al. The atherogenic index of plasma plays an important role in predicting the prognosis of type 2 diabetic subjects undergoing percutaneous coronary intervention: results from an observational cohort study in China. Cardiovasc Diabetol 2020; 9: 23.
• Schwartz GG, Abt M, Bao W, et al. Fasting triglycerides predict recurrent ischemic events in patients with acute coronary syndrome treated with statins. J Am Coll Cardiol 2015; 65: 2267-75.
• Nakazawa M, Arashi H, Yamaguchi J, Ogawa H, Hagiwara N. Lower levels of high-density lipoprotein cholesterol are associated with increased cardiovascular events in patients with acute coronary syndrome. Atherosclerosis 2020; 303: 21-8.
• Edwards MK, Blaha MJ, Loprinzi PD. Influence of sedentary behavior, physical activity, and cardiorespiratory fitness on the atherogenic index of plasma. J Clin Lipidol 2017; 11: 119-25.
• Reyes-Ferrada W, Solis-Urra P, Plaza-Díaz J, et al. Cardiorespiratory fitness, physical activity, sedentary time and ıts association with the atherogenic ındex of plasma in chilean adults: ınfluence of the waist circumference to height ratio. Nutrients 2020; 12: 1250.