ArticleEuropean journal of preventive cardiology2023
U-shaped relationship between apolipoprotein A1 levels and mortality risk in men and women.
Article in European journal of preventive cardiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Effect of reducing saturated fat intake on cardiovascular disease in adults: an umbrella review.Frontiers in public health · 2024Pooled it
- Effects of a cardioprotective nutritional program on apolipoproteins and lipids in secondary cardiovascular disease prevention.Archives of endocrinology and metabolism · 2025Trial
- High-Density Lipoprotein Treatment Effectively Protected the Endothelial Cells, Mitochondria and Myocardium Against Oxidized Low-Density Lipoprotein Damage.Acta Cardiologica Sinica · 2026Article
- Integrative Proteomic Profiling of Blood Pressure and Hypertension.Hypertension (Dallas, Tex. : 1979) · 2026Article
- Elevated levels of apolipoprotein C3 impair platelet function and reduce thrombosis.Journal of thrombosis and haemostasis : JTH · 2026Article
- Association of HDL subclass components with all-cause and cardiovascular mortality: a prospective cohort study based on the ChinaHEART project.Lipids in health and disease · 2026Observational
- The inflammatory marker SIRI acts as a statistical mediator between ApoB/ApoA1 ratio and atrial fibrillation, and combined biomarkers show higher discriminative ability for the presence of atrial fibrillation than single indicators.Frontiers in cardiovascular medicine · 2026Article
- Methylome-wide association studies and epigenetic biomarker development for 133 mass spectrometry-assessed circulating proteins in 14,671 Generation Scotland participants.Genome biology · 2025Article
- Impact of Glucose Metabolism Status on the Association between Apolipoprotein A-I and Ischemic Risk in Patients with Coronary Artery Disease: A Large-Sample Cohort Study.Endocrinology and metabolism (Seoul, Korea) · 2025Article
- Long-term trajectories of apolipoprotein A1 and major adverse cardiovascular events and mortality in a community cohort.Lipids in health and disease · 2025Article
- Serum Lipid Biomarkers and the Risk of Gastrointestinal Cancers in a Chinese Population: The Kailuan Prospective Study.Cancer medicine · 2025Article
- U-Shaped association between apolipoprotein A1 and serum uric acid levels in patients with osteoporotic fractures: a cross-sectional study.Frontiers in endocrinology · 2025Article
- Insulin resistance as potential mediator linking ApoB/ApoA1 to MAFLD, but not inflammation.Therapeutic advances in endocrinology and metabolism · 2025Article
- Differences in HDL Remodeling during Healthy Pregnancy and Pregnancy with Cardiometabolic Complications.Antioxidants (Basel, Switzerland) · 2024Article
- Does Elevated High-Density Lipoprotein Cholesterol Protect Against Cardiovascular Disease?The Journal of clinical endocrinology and metabolism · 2024Article
- High-Density Lipoprotein Cholesterol in Atherosclerotic Cardiovascular Disease Risk Assessment: Exploring and Explaining the "U"-Shaped Curve.Current cardiology reports · 2023Review
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Abstract
backgroundApolipoprotein A1 (ApoA1) is the principal protein component of high-density lipoprotein (HDL). Although low HDL cholesterol (HDL-C) levels are known to be associated with greater cardiovascular risk, recent studies have also shown heightened mortality risk at very high HDL-C levels.
aimsTo investigate the sex-specific association between elevated ApoA1 levels and adverse outcomes, and their genetic basis.
methodsA prospective cohort study of United Kingdom Biobank participants without coronary artery disease at enrollment was performed. The primary exposure was serum ApoA1 levels. The primary and secondary outcome measures were cardiovascular and all-cause death, respectively.
resultsIn 402 783 participants followed for a median of 12.1 years, there was a U-shaped relationship between ApoA1 levels and both cardiovascular as well as all-cause mortality, after adjustment for traditional cardiovascular risk factors. Individuals in the highest decile of ApoA1 levels (1.91-2.50 g/L) demonstrated higher cardiovascular (HR 1.21, 95% CI 1.07-1.37, P < 0.0022) and all-cause mortality (HR 1.14, 95% CI 1.07-1.21, P < 0.0001) compared with those within the lowest risk eighth decile (1.67-1.75 g/L). The U-shaped relationship was present in both sexes, though more pronounced in men. Sensitivity analyses showed that cardiovascular mortality rates were higher in those with greater alcohol intake (P < 0.004). Adjustment for polygenic variation associated with higher ApoA1 levels did not attenuate the effect of very high ApoA1 levels on mortality. In the sub-group with very elevated HDL-C levels (> 80 mg/dL in men, > 100 mg/dL in women), there was no association between ApoA1 levels and mortality.
conclusionBoth very low and very elevated ApoA1 levels are associated with higher cardiovascular and all-cause mortality.
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