Abstract 2958: Patients with Low Plasma Levels of Apolipoprotein A-I Have a Worse Prognosis in Non-ischemic Heart Failure
There is extensive evidence that patients with low plasma levels of HDL and apolipoprotein A-I (apoA-I) have a worse prognosis in ischemic heart disease. However, the clinical significance of apoA-I levels in non-ischemic heart disease remains unknown. It has been shown that apoA-I has an anti-inflammatory action, and that an increase in systemic inflammation plays a critical role in the pathogenesis of heart failure (HF). Thus, we hypothesized that apoA-I levels may also have a role in the pathophysiology of non-ischemic HF.
Methods and Results: Plasma levels of apoA-I were measured by immunoturbidimetry in 117 consecutive patients with non-ischemic HF (no angiographically documented organic coronary stenosis ≥75%; 72 patients in NYHA class II, 22 in NYHA III, 23 in NYHA IV) and 87 age- and sex-matched controls. ApoA-I levels were significantly lower in non-ischemic HF than controls (119.5 ± 27.0 vs. 142.0 ± 21.4 mg/dl, p < 0.0001), and patients with higher NYHA class had lower apoA-I levels (ρ = −0.45, p < 0.0001 by Spearman rank correlation test). During the prospective follow-up period (mean, 22.0 months), 31 (26.5%) patients had one of the following clinical cardiovascular events: non-cardiac death in 8 patients, cardiac death in 9, hospitalization with worsening HF in 15, and stroke in 3. Kaplan-Meier analysis demonstrated a significantly higher probability of events in patients with lower apoA-I levels (< 115 mg/dl, the median level) (p = 0.007 by log-rank test). A multivariate Cox hazards analysis showed that lower apoA-I levels were a significant predictor of poor prognosis, independently of age, LVEF, use of medications, and levels of HDL, apoA-II, BNP, and serum creatinine (odds ratio 5.2, 95%CI 1.4 - 20.3, p = 0.02). HDL and apoA-II levels did not have a significant association with the prognosis in these patients. ApoA-I was inversely correlated with levels of C-reactive protein (r = - 0.23, p = 0.02) and fibrinogen (r = −0.24, p = 0.02), established inflammatory markers of poor prognosis in HF.
Conclusions: Low levels of apoA-I are a significant and independent predictor of poor prognosis in patients with non-ischemic HF. ApoA-I may play a pathophysiological role in non-ischemic HF possibly through an anti-inflammatory action.