Circulating apo B to A1 ratio reflects the progression of chronic heart failure with different etiologies

Abstract Backgrounds: Apolipoprotein (apo) B and apo A1 are major protein component of low-density lipoprotein and high-density lipoprotein particles, which are closely linked to lipid metabolism, atherosclerosis, and endothelial function. We sought to investigate whether circulating apoB/A1 ratio could serve as a potential metabolic risk factor for the progression of chronic heart failure (HF). Methods Serum levels of apo B and apo A1 were measured in 1299 consecutive patients with clinical symptoms of chronic HF. Left ventricular ejection fraction (EF) and E/e’ were determined by two-dimensional echocardiography and Doppler flow imaging using standard biplane technique. The relationship of apo B/A1 ratio to classification and etiology of HF was examined. Results Overall, apoB/A1 ratio was gradually decreased from HF with reduced EF (HFrEF), HF with mid-range reduced EF (HFmrEF), to HF with preserved EF (HFpEF), and correlated negatively with left ventricular EF (r=-0.162, p < 0.001)but positively with E/e’ (r = 0.147, P < 0.001). After adjustment for conventional factors, apoB/A1 ratio remained an independent risk factor for HFrEF or HFmrEF (P < 0.05). Further analysis revealed that apoB/A1 ratio was significantly associated with HF classification in patients whose HF was caused by hypertensive heart disease or ischemic cardiomyopathy (all p < 0.05), Conclusions In patients with chronic HF, elevated circulating apoB/A1 ratio confers an increased risk for worsened left ventricular dysfunction, especially for those with hypertensive heart disease or severe coronary artery disease.