Abstract 3151: Inflammatory Markers and Risk of Coronary Heart Disease in Relation to the Apob/Apoa-i Ratio in Healthy Men and Women; The Epic-Norfolk Population Study
Studies have shown that individuals with an elevated apoB/apoA-I ratio are at increased risk for CHD. Presence of higher levels of inflammatory markers is also associated with increased CHD risk. The respective contributions of the apoB/apoA-I ratio and inflammatory markers to CHD risk are unknown. The apoB/apoA-I ratio and the plasma concentrations of an extensive panel of inflammatory markers including CRP, adiponectin, fibrinogen, myeloperoxidase, secretory phospholipase A2 (sPLA2) as well as lipoprotein-associated phospholipase A2 (Lp-PLA2) activity were measured in a prospective case-control study of 844 cases and 1762 matched controls (1651 men and 955 women) aged between 45–79 years who participated to the EPIC-Norfolk prospective population study. In both sexes, compared to participants in bottom apoB/apoA-I ratio tertile, participants in the top tertile had the highest levels of CRP (4.4 [3.7–5.0] vs. 2.8 [2.4 –3.2] mg/dL, p<0.001 in men and 4.1 [3.4 – 4.8] vs. 3.1 [2.6 –3.6] mg/dL, p=0.03 in women), fibrinogen (3.2 [3.1–3.2] vs. 2.9 [2.8 –2.9] g/L, p<0.001 in men and 3.2 [3.1–3.2] vs. 3.0 [2.9 –3.1] g/L, p<0.001 in women) and the highest Lp-PLA2 activity (60.7 [59.3– 62.1] vs. 47.3 [46.0 – 48.6] nmol/min/mL, p<0.001 in men and 55.6 [53.8 –57.4] vs. 41.5 [40.2– 42.8] nmol/min/mL, p<0.001 in women) and the lowest adiponectin levels (7.9 [7.6 – 8.3] vs. 10.2 [9.7–10.6] μg/mL, p<0.001 in men and 11.3 [12.7–13.5] vs. 15.5 [14.6 –16.1] μg/mL, p<0.001). Myeloperoxidase and sPLA2 levels did not differ in apoB/apoA-I ratio tertiles. Compared to men in the bottom apoB/apoA-I ratio tertile and only 0 or 1 inflammatory markers in the top tertile (bottom for adiponectin), men in the top apoB/apoA-I ratio tertile had odds ratio (OR) for future CHD of 1.7 [95%CI 1.1–2.5], whereas those with 4, 5 or 6 inflammatory markers in the top tertile had an OR of 2.1 [1.4 –3.1] for future CHD. Among women, these OR for future CHD were of 1.7 [1.05–2.9] and 2.2 [1.2–3.9]. Men and women with an elevated apoB/apoA-I ratio also exhibited increased levels of inflammatory markers. The presence of additional elevated levels of multiple inflammatory markers was associated with an elevated CHD risk independent of higher levels of apoB/apoA-I ratio.