Preliminary evidence on the diagnostic value of apolipoprotein B and A-I in peripheral artery disease among Vietnamese patients with diabetes
Main Article Content
Abstract
To evaluate the value of apolipoprotein A-I, B, and the apoB/AI ratio in the diagnostic of peripheral artery disease among patients with diabetes, we conducted a cross-sectional study of which they underwent clinical evaluation, standardized Doppler ultrasound and blood test. Area under the Receiver Operating Characteristic curve method was employed to estimate the discriminatory ability of apolipoprotein A-I, apolipoprotein B, and the ApoB/A-I ratio. A total of 159 patients were included. ApoA-I, ApoB, and the ApoB/A-I ratio show statistically significant associations with most clinical and Doppler ultrasound characteristics of PAD. In Pearson’s correlation analysis, apolipoproteins showed a stronger correlation with ABI than the traditional lipid profile. The AUROC was 0.714 (95%CI: 0.635 - 0.794); 0.300 (95%CI: 0.219 – 0.380) and 0.604 (95%CI: 0.516 – 0.692) for apoB/A-I ratio; apoAI and apoB, respectively. The probability apoB/A-I cutoff of 0.666 had a sensitivity of 0.682 and a specificity of 0.662. Apolipoprotein AI and Apolipoprotein B are tests with considerable potential in diagnosing peripheral arterial disease in patients of type 2 diabetes mellitus patients. Further studies are needed with larger sample sizes, and employing imaging diagnostic modalities with higher reliability as the gold standard (MSCT angiography).
Article Details
Keywords
PAD, diabetes, apolipoprotein, doppler, cholesterol
References
2. Almourani R, Chinnakotla B, Patel R, et al. Diabetes and Cardiovascular Disease: An Update. Curr Diab Rep. 2019;19(12):161.
3. American Diabetes Association. Peripheral arterial disease in people with diabetes. Diabetes Care. 2003;26(12):3333-3341.
4. 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.
5. Walldius G, Jungner I, Holme I, et al. High apolipoprotein B, low apolipoprotein A-I, and improvement in the prediction of fatal myocardial infarction (AMORIS study): a prospective study. Lancet Lond Engl. 2001;358(9298):2026-2033.
6. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet Lond Engl. 2004;364(9438):937-952.
7. Walldius G, Aastveit AH, Jungner I. Stroke mortality and the apoB/apoA-I ratio: results of the AMORIS prospective study. J Intern Med. 2006;259(3):259-266.
8. Bhatia M, Howard SC, Clark TG, et al. Apolipoproteins as predictors of ischaemic stroke in patients with a previous transient ischaemic attack. Cerebrovasc Dis Basel Switz. 2006;21(5-6):323-328.
9. Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135(12).
10. Forte F, Calcaterra I, Lupoli R, et al. Association of apolipoprotein levels with peripheral arterial disease: a meta-analysis of literature studies. Eur J Prev Cardiol. 2022;28(18):1980-1990.
11. Rahmani M, Raiszadeh F, Allahverdian S, et al. Coronary artery disease is associated with the ratio of apolipoprotein A-I/B and serum concentration of apolipoprotein B, but not with paraoxonase enzyme activity in Iranian subjects. Atherosclerosis. 2002;162(2):381-389.
12. Westerveld HT, van Lennep JE, van Lennep HW, et al. Apolipoprotein B and coronary artery disease in women: a cross-sectional study in women undergoing their first coronary angiography. Arterioscler Thromb Vasc Biol. 1998;18(7):1101-1107.
13. Hua R, Li Y, Li W, et al. Apolipoprotein B/A1 Ratio Is Associated with Severity of Coronary Artery Stenosis in CAD Patients but Not in Non-CAD Patients Undergoing Percutaneous Coronary Intervention. Dis Markers. 2021;2021:8959019.
14. Li MM, Lin YY, Huang YH, et al. Association of Apolipoprotein A1, B with Stenosis of Intracranial and Extracranial Arteries in Patients with Cerebral Infarction. Clin Lab. 2015;61(11):1727-1735.
15. Walldius G, Jungner I, Aastveit AH, et al. 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):1355-1363.
16. Zhan S, Tang M, Liu F, et al. Ezetimibe for the prevention of cardiovascular disease and all-cause mortality events. Cochrane Database Syst Rev. 2018;11(11):CD012502.
17. Schwartz GG, Steg PG, Szarek M, et al. Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome. N Engl J Med. 2018;379(22):2097-2107.
18. Giugliano RP, Pedersen TR, Park JG, et al. Clinical efficacy and safety of achieving very low LDL-cholesterol concentrations with the PCSK9 inhibitor evolocumab: a prespecified secondary analysis of the FOURIER trial. Lancet Lond Engl. 2017;390(10106):1962-1971.
19. Cholesterol Treatment Trialists’ (CTT) Collaborators, Mihaylova B, Emberson J, et al. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet Lond Engl. 2012;380(9841):581-590.