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. 2022 Nov 1;151(9):1482-1490.
doi: 10.1002/ijc.34164. Epub 2022 Jul 7.

Low apolipoprotein A1 was associated with increased risk of cancer mortality in patients following percutaneous coronary intervention: A 10-year follow-up study

Hiroki Nishiyama  1 , Takehiro Funamizu  1 , Hiroshi Iwata  1 , Hirohisa Endo  1 , Yuichi Chikata  1 , Shinichiro Doi  1 , Hideki Wada  2 , Ryo Naito  1 , Manabu Ogita  2 , Yoshiteru Kato  1 , Iwao Okai  1 , Tomotaka Dohi  1 , Takatoshi Kasai  1 , Kikuo Isoda  3 , Shinya Okazaki  1 , Katsumi Miyauchi  1 , Tohru Minamino  1
Affiliations

Low apolipoprotein A1 was associated with increased risk of cancer mortality in patients following percutaneous coronary intervention: A 10-year follow-up study

Hiroki Nishiyama et al. Int J Cancer. .

Abstract

Previous studies showed that elevated apolipoprotein A1 (ApoA1) and high-density lipoprotein cholesterol (HDL-C) predicted reduced risk of cardiovascular-related (CV) mortality in patients following percutaneous coronary intervention (PCI). Nevertheless, as the association between ApoA1 and cancer mortality in this population has been rarely addressed, our study aimed to evaluate prognostic impact of ApoA1 on multiple types of cancer mortality after PCI. This is a retrospective analysis of a single-center prospective registry database of patients who underwent PCI between 2000 and 2018. The present study enrolled 3835 patients whose data of serum ApoA1 were available and they were divided into three groups according to the tertiles of the preprocedural level of ApoA1. The outcome measures were total, gastrointestinal, and lung cancer mortalities. The median and range of the follow-up period between the index PCI and latest follow-up were 5.9 and 0-17.8 years, respectively. Consequently, Kaplan-Meier analyses showed significantly higher rates of the cumulative incidences of total, gastrointestinal, and lung cancer mortality in the lowest ApoA1 tertile group compared to those in the highest. In contrast, there were no significant differences in all types of cancer mortality rates in the groups divided by the tertiles of HDL-C. Multivariable Cox proportional hazard regression analysis adjusted by cancer-related prognostic factors, such as smoking status, identified the elevated ApoA1 as an independent predictor of decreased risk of total and gastrointestinal cancer mortalities. Our study demonstrates the prognostic implication of preprocedural ApoA1 for predicting future risk of cancer mortality in patients undergoing PCI.

Keywords: apolipoprotein A1; cancer mortality; high-density lipoprotein cholesterol; percutaneous coronary intervention.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Cumulative cancer mortality rates in groups divided by tertiles of preprocedural ApoA1. Cumulative rates of (A) total, (B) GI, and (C) lung cancer mortality. ApoA1, apolipoprotein A1; GI, gastrointestinal [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 2
FIGURE 2
Unadjusted and multivariate adjusted (Models 1 and 2) prognostic impact of preprocedural ApoA1 level in patients for total, GI, and lung cancer mortalities. Hazard ratios (HR) and 95% confidence intervals (95% CIs) for (A) total, (B) GI, and (C) lung cancer mortalities, respectively. For multivariate analysis, Model 1 was adjusted by age, sex, and any smoking history, and Model 2 additionally included hypertension, diabetes, serum LDL‐C level, chronic kidney disease, BMI, use of ACEI/ARB, use of statins, and serum hs‐CRP level, respectively. Closed rhombuses indicate a significant (P < .05) association of 1 − SD elevation of ApoA1 with endpoints. ACEI/ARB, angiotensin converting enzyme inhibitors/angiotensin receptor blockers; ApoA1, apolipoprotein A1; BMI, body mass index; GI, gastrointestinal; hs‐CRP, high‐sensitivity C‐reactive protein; LDL‐C, low density lipoprotein cholesterol
FIGURE 3
FIGURE 3
Cubic spline curves and histograms of serum ApoA1 level for the risk of total and GI cancer mortalities following PCI. Hazard ratios (solid lines) and 95% confidence intervals (dotted lines) for total (A) and GI (B) cancer mortalities as a reference ApoA1 value of 110 mg/dL and histograms of serum level of ApoA1. The Cox model included age, sex, any smoking history, hypertension, diabetes, serum LDL‐C level, chronic kidney disease, body mass index, use of ACEI/ARB, use of statins and serum hs‐CRP level (Model 2). ACEI/ARB, angiotensin converting enzyme inhibitors/angiotensin receptor blockers; ApoA1, apolipoprotein A1; GI, gastrointestinal; hs‐CRP, high‐sensitivity C‐reactive protein; LDL‐C, low density lipoprotein cholesterol; PCI, percutaneous coronary intervention
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