The role of the plasma glycosylated hemoglobin A1c/Apolipoprotein A-l ratio in predicting cardiovascular outcomes in acute coronary syndrome

• Published in: Nutrition, metabolism, and cardiovascular diseases metabolism, and cardiovascular diseases, 2021-02, Vol.31 (2), p.570-578
• Main Authors: Song, Feier, Zhou, Yu, Zhang, Kunyi, Liang, Yuan-Feng, He, Xuyu, Li, Liwen
• Format: Article
• Language: English
• Subjects: Acute coronary syndrome; Acute Coronary Syndrome - blood; Acute Coronary Syndrome - diagnostic imaging; Acute Coronary Syndrome - mortality; Aged; Apolipoprotein A-1; Apolipoprotein A-I - blood; Biomarkers - blood; Coronary Angiography; Female; Glucose; Glycated Hemoglobin A - analysis; Glycosylated hemoglobin A1c; Humans; Insulin Resistance; Lipid; Longitudinal Studies; Male; Middle Aged; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors
• ISSN: 0939-4753; 1590-3729
• DOI: 10.1016/j.numecd.2020.10.008

Glucose and lipid metabolism are major prognostic indicators of coronary heart disease. The ratio of plasma glycosylated hemoglobin A1c (HbA1c) to apolipoprotein A-l (ApoA-l) is an indirect measure of insulin resistance. The study aimed to evaluate whether the HbA1c/ApoA-1 ratio can predict the prognosis in patients with the acute coronary syndrome (ACS). A total of 476 ACS patients diagnosed by coronary angiography were enrolled in this longitudinal, observational, retrospective study. Plasma HbA1c, fasting blood glucose and lipid profile were measured. Patients were stratified according to the tertiles of HbA1c/ApoA-l levels. Cox proportional hazard model was used to examine the predictive value of HbA1c/ApoA-l for study endpoints. The association between the Log HbA1c/ApoA-l ratio and major adverse cardiovascular events (MACEs) was estimated using multiple logistic regression. Baseline characteristics showed a mean age of 66 ± 8 years, and 52.5% were hypertensive, 26.8% diabetic, and 54.5% current or prior smokers. During a mean follow-up period of 22.3 ± 1.7 months, 59 deaths occurred. After adjusting for age, gender, smoking, hypertension, diabetes, and coronary artery disease severity, patients in the highest HbA1c/ApoA-l ratio tertile had a 4.36-fold increased risk of mortality compared with those in the lowest tertile. The multivariate logistic regression showed that the Log HbA1c/ApoA-l ratio was associated with MACEs (Odds ratio 2.95, p = 0.013). After adjusting for traditional cardiovascular risk factors and ACS severity scores, the HbA1c/ApoA-1 ratio remained an independent predictor of all-cause mortality and MACEs in the ACS patients undergoing angiography. •476 ACS patients were enrolled in this longitudinal, observational, retrospective study.•All-cause mortality was 23.1%, 12.9%, 9.0% in the high, middle, low HbA1c/ApoA-l ratio group during a mean 22-month follow-up.•The HbA1c/ApoA-l ratio predicted major adverse cardiovascular events and mortality.•Patients with a high HbA1c/ApoA-l ratio had a 4.36-fold increased risk of mortality compared with those in the low ratio.•Per-unit increase in Log HbA1c/ApoA-1 ratio had a 2.96-fold increased risk of MACEs.