Background: Apolipopoprotein C-III (Apo C-III) plays a pivotal role in controlling plasma triglyceride and contributes to the atherogenic properties of triglyceride-rich lipoproteins. A high Apo C-III concentration has been suggested as a independent predictor of cardiovascular mortality. The aim of this study was to investigate the prognostic value of Apo C-III concentration for mortality in patients from the Verona Heart Study (VHS) with angiographically proven coronary artery disease (CAD) who mainly underwent coronary revascularization. Methods: A cohort of 633 CAD patients from the Verona Heart Study was prospectively followed for a median follow-up of 57 months. For all these subjects data about Apo C-III levels were available. In a subgroup of 221 subjects data about thrombin generation were also available (Endogenous Thrombin Potential Assay for Research use only, Siemens Healthcare Diagnostics Products GmbH, Marburg, Germany). Results: During follow-up 91 patients (14.4%) had died; of them, 64 (70.3%) died because of cardiovascular events. After adjustment for all the other predictors of mortality at univariate analysis (i.e. age, statin therapy, myocardial infarction history, diabetes, hs-CRP and creatinine) elevated Apo C-III levels (> 10.5 mg/dL – the median value) significantly predicted both total and cardiovascular mortality (HR for total mortality 2.02 with 95%CI 1.13–3.62; HR for cardiovascular mortality 2.23 with 95%CI 1.09–4.57, respectively). In the subgroup analysis high Apo C-III levels were associated with a high thrombin generation, also after adjustment for other lipid parameters (standardized beta-coefficient 0.212, P = 0.003). Conclusions: In a population with defined CAD high Apo C-III levels are independent predictors of total and cardiovascular mortality. Moreover, our data suggest that high Apo C-III levels may be associated with a prothrombotic state.
High plasma apolipoprotein C-III levels predict total and cardiovascular mortality in patients with angiographically defined coronary artery disease.
MARTINELLI, Nicola;GIRELLI, Domenico;FRISO, Simonetta;PIZZOLO, Francesca;GUARINI, Patrizia;Bassi, Antonella;GUIDI, Giancesare;CORROCHER, Roberto;OLIVIERI, Oliviero
2009-01-01
Abstract
Background: Apolipopoprotein C-III (Apo C-III) plays a pivotal role in controlling plasma triglyceride and contributes to the atherogenic properties of triglyceride-rich lipoproteins. A high Apo C-III concentration has been suggested as a independent predictor of cardiovascular mortality. The aim of this study was to investigate the prognostic value of Apo C-III concentration for mortality in patients from the Verona Heart Study (VHS) with angiographically proven coronary artery disease (CAD) who mainly underwent coronary revascularization. Methods: A cohort of 633 CAD patients from the Verona Heart Study was prospectively followed for a median follow-up of 57 months. For all these subjects data about Apo C-III levels were available. In a subgroup of 221 subjects data about thrombin generation were also available (Endogenous Thrombin Potential Assay for Research use only, Siemens Healthcare Diagnostics Products GmbH, Marburg, Germany). Results: During follow-up 91 patients (14.4%) had died; of them, 64 (70.3%) died because of cardiovascular events. After adjustment for all the other predictors of mortality at univariate analysis (i.e. age, statin therapy, myocardial infarction history, diabetes, hs-CRP and creatinine) elevated Apo C-III levels (> 10.5 mg/dL – the median value) significantly predicted both total and cardiovascular mortality (HR for total mortality 2.02 with 95%CI 1.13–3.62; HR for cardiovascular mortality 2.23 with 95%CI 1.09–4.57, respectively). In the subgroup analysis high Apo C-III levels were associated with a high thrombin generation, also after adjustment for other lipid parameters (standardized beta-coefficient 0.212, P = 0.003). Conclusions: In a population with defined CAD high Apo C-III levels are independent predictors of total and cardiovascular mortality. Moreover, our data suggest that high Apo C-III levels may be associated with a prothrombotic state.
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