Association of Apolipoprotein-A, B and Trans Fatty Acids with Cardiovascular Events: Isfahan Cohort Study

Document Type : Original Article(s)

Authors

1 Professor, Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

2 Pharmacognosist, Basic Sciences, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfa-han, Iran.

3 General Practitioner, Quality Control Unit, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

4 General Practitioner, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

5 Cardiologist, Department of Cardiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

6 MSc in Physiology, Laboratory of Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

7 Associate Professor, Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Abstract

Background: Various studies have shown that the risk of apolipoprotein-A (apo-A), B (apo-B), and trans fatty acids may be different for cardiovascular disease (CVD) events in different populations. This study aimed to estimate the relative risk of apo-A, apo-B, and trans fatty acids for the occurrence of cardiovascular disease events in a cohort study.Methods: A cohort study was performed on 5375 subjects aged ≥ 35 years old participating in the Isfahan Healthy Heart Program (IHHP) that had been recruited with multistage cluster random sampling method. Apo-A and apo-B were measured in all subjects while trans fatty acids were measured on a random sample of 238 subjects. The relative risk of these factors for CVD events was defined in a 6-year period. T-test was used to compare means. Logistic regression and Cox regression were used to calculate Hazard ratio of cardiovascular disease events.Finding: After adjustment for age and sex, the relative risk for cardiovascular disease events was 2.393 (95%CI 1.155-4.961) for apo-B/A, 1.007 (95%CI 1.004-1.009) for total cholesterol, 1.002 (95%CI 1.001-1.003) for triglycerides, and 1.008 (95%CI 1.005-1.010) for LDL-cholesterol. After adjustment for smoking, diabetes, hypertension, and obesity, the relative risk for total cholesterol (1.006, 95%CI 1.003-1.008) and LDL-cholesterol 1.007, 95%CI 1.004-1.010) was significant while insignificant for trans fatty acids.Conclusion: This study showed that relative risk of apo-B/A for cardiovascular disease events is similar to total cholesterol and LDL-cholesterol. However, after adjustment for other risk factors, the association remained significant only for total cholesterol and LDL-cholesterol. Trans fatty acids did not show significant risk for cardiovascular disease event.  

Keywords


  1. Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: Part II: variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies. Circulation 2001; 104(23): 2855-64.
  2. Vartiainen E, Puska P, Pekkanen J, Tuomilehto J, Jousilahti P. Changes in risk factors explain changes in mortality from ischaemic heart dis-ease in Finland. BMJ 1994; 309(6946): 23-7.
  3. Walldius G, Jungner I. Apolipoprotein B and apolipoprotein A-I: risk indicators of coronary heart disease and targets for lipid-modifying therapy. J Intern Med 2004; 255(2): 188-205.
  4. Walldius G, Jungner I, Holme I, Aastveit AH, Kolar W, Steiner E. High apolipoprotein B, low apolipoprotein A-I, and improvement in the prediction of fatal myocardial infarction (AMORIS study): a prospective study. Lancet 2001; 358(9298): 2026-33.
  5. Meisinger C, Loewel H, Mraz W, Koenig W. Prognostic value of apolipoprotein B and A-I in the prediction of myocardial infarction in middle-aged men and women: results from the MONICA/KORA Augsburg cohort study. Eur Heart J 2005; 26(3): 271-8.
  6. Sniderman AD, Furberg CD, Keech A, Roeters van Lennep JE, Frohlich J, Jungner I, et al. Apolipoproteins versus lipids as indices of coronary risk and as targets for statin treatment. Lancet 2003; 361(9359): 777-80.
  7. Walldius G, Jungner I, Aastveit AH, Holme I, Furberg CD, Sniderman AD. The apoB/apoA-I ratio is better than the cholesterol ratios to estimate the balance between plasma proatherogenic and antiatherogenic lipoproteins and to predict coronary risk. Clin Chem Lab Med 2004; 42(12): 1355-63.
  8. Wallenfeldt K, Bokemark L, Wikstrand J, Hulthe J, Fagerberg B. Apolipoprotein B/apolipoprotein A-I in relation to the metabolic syndrome and change in carotid artery intima-media thickness during 3 years in middle-aged men. Stroke 2004; 35(10): 2248-52.
  9. Walldius G, Jungner I. Rationale for using apolipoprotein B and apolipoprotein A-I as indicators of cardiac risk and as targets for lipid-lowering therapy. Eur Heart J 2005; 26(3): 210-2.
  10. Lichtenstein AH. Trans fatty acids, plasma lipid levels, and risk of developing cardiovascular disease. A statement for healthcare professionals from the American Heart Association. Circulation 1997; 95(11): 2588-90.
  11. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364(9438): 937-52.
  12. Haidari M, Moghadam M, Chinicar M, Ahmadieh A, Doosti M. Apolipoprotein B as the best predictor of coronary artery disease in Iranian normolipidemic patients. Clin Biochem 2001; 34(2): 149-55.
  13. Arab L, Akbar J. Biomarkers and the measure-ment of fatty acids. Public Health Nutr 2002; 5(6A): 86571.
  14. Sun Q, Ma J, Campos H, Rexrode KM, Albert CM, Mozaffarian D, et al. Blood concentrations of individual long-chain n-3 fatty acids and risk of nonfatal myocardial infarction. Am J Clin Nutr 2008; 88(1): 216-23.
  15. Lemaitre RN, King IB, Mozaffarian D, Sotoodehnia N, Rea TD, Kuller LH, et al. Plasma phospholipid trans fatty acids, fatal ischemic heart disease, and sudden cardiac death in older adults: the cardiovascular health study. Circulation 2006; 114(3): 209-15.
  16. Sun Q, Ma J, Campos H, Hankinson SE, Manson JE, Stampfer MJ, et al. A prospective study of trans fatty acids in erythrocytes and risk of coronary heart disease. Circulation 2007; 115(14): 1858-65.
  17. Mozaffarian D, Abdollahi M, Campos H, Houshiarrad A, Willett WC. Consumption of trans fats and estimated effects on coronary heart disease in Iran. Eur J Clin Nutr 2007; 61(8): 1004-10.
  18. Sarraf-Zadegan N, Boshtam M, Malekafzali H, Bashardoost N, Sayed-Tabatabaei FA, Rafiei M, et al. Secular trends in cardiovascular mortality in Iran, with special reference to Isfahan. Acta Cardiol 1999; 54(6): 327-33.
  19. Sarrafzadegan N, Oveisgharan SH, Toghianifar N, Hosseini SH, Rabiei K. Acute myocardial infarction in Isfahan, Iran: Hospitalization and 28th day case-fatality rate. ARYA Atherosclerosis Journal 2009; 5(3): 132-7.
  20. Sarraf-Zadegan N, Sayed-Tabatabaei FA, Ba-shardoost N, Maleki A, Totonchi M, Habibi HR, et al. The prevalence of coronary artery disease in an urban population in Isfahan, Iran. Acta Cardiol 1999; 54(5): 257-63.
  21. Hatmi ZN, Tahvildari S, Gafarzadeh MA, Sab-ouri KA. Prevalence of coronary artery disease risk factors in Iran: a population based survey. BMC Cardiovasc Disord 2007; 7: 32.
  22. Sarraf-Zadegan N, Sadri G, Malek AH, Baghaei M, Mohammadi FN, Shahrokhi S, et al. Isfahan Healthy Heart Programme: a comprehensive integrated community-based programme for cardiovascular disease prevention and control. Design, methods and initial experience. Acta Cardiol 2003; 58(4): 309-20.
  23. Sarrafzadegan N, Baghaei AM, Sadri GH, Keli-shadi R, Malekafzali H, Boshtam M, et al. Isfa-han healthy heart program: Evaluation of comprehensive, community-based interventions for non-communicable disease prevention. Prevention and Control 2006; 2(2): 73-84.
  24. Sarrafzadegan N, Talaei M, Sadeghi M, Keli-shadi R, Oveisgharan S, Mohammadifard N, et al. The Isfahan cohort study: Rationale, methods and main findings. J Hum Hypertens 2010. [Epub ahead of print].
  25. .Mohammadifard N, Kelishadi R, Safavi M, Sarrafzadegan N, Sajadi F, Sadri GH, et al. Effect of a community-based intervention on nutritional behaviour in a developing country setting: the Isfahan Healthy Heart Programme. Public Health Nutr 2009; 12(9): 1422-30.
  26. Sierra-Johnson J, Fisher RM, Romero-Corral A, Somers v, Lopez-Jimenez F, Ohrvik J, et al. Concentration of apolipoprotein B is com-parable with the apolipoprotein B/apolipoprotein A-I ratio and better than routine clinical lipid measurements in predicting coronary heart disease mortality: findings from a multi-ethnic US population. European Heart Journal 2011; 30(6): 710-7.
  27. Edelstein C, Hinman J, Marcovina S, Scanu AM. Properties of human free apolipoprotein(a) and lipoprotein(a) after either freezing or lyophilization in the presence and absence of cryopreservatives. Anal Biochem 2001; 288(2): 201-8.
  28. Brown SA, Epps DF, Dunn JK, Sharrett AR, Patsch JR, Gotto AM, et al. Effect of blood collection and processing on radioimmunoassay results for apolipoprotein B in plasma. Clin Chem 1990; 36(9): 1662-6.
  29. McNamara JR, Campos H, Ordovas JM, Peter-son J, Wilson PW, Schaefer EJ. Effect of gender, age, and lipid status on low density lipoprotein subfraction distribution. Results from the Framingham Offspring Study. Arteriosclerosis 1987; 7(5): 483-90.
  30. Mozaffarian D, Katan MB, Ascherio A, Stampfer MJ, Willett WC. Trans fatty acids and cardiovascular disease. N Engl J Med 2006; 354(15): 1601-13.
  31. Pietinen P, Ascherio A, Korhonen P, Hartman AM, Willett WC, Albanes D, et al. Intake of fatty acids and risk of coronary heart disease in a cohort of Finnish men. The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Am J Epidemiol 1997; 145(10): 876-87.