Apolipoprotein B/Apolipoprotein A-I Ratio Is a Better Predictor of Cancer Mortality Compared with C-Reactive Protein: Results from Two Multi-Ethnic US Populations

Mohsen Mazidi; Niki Katsiki; Dimitri P Mikhailidis; Dina Radenkovic; Daniel Pella; Maciej Banach

doi:10.3390/jcm9010170

Apolipoprotein B/Apolipoprotein A-I Ratio Is a Better Predictor of Cancer Mortality Compared with C-Reactive Protein: Results from Two Multi-Ethnic US Populations

J Clin Med. 2020 Jan 8;9(1):170. doi: 10.3390/jcm9010170.

Authors

Mohsen Mazidi¹, Niki Katsiki², Dimitri P Mikhailidis³, Dina Radenkovic⁴, Daniel Pella⁵, Maciej Banach^{6

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Affiliations

¹ Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Hospital, Strand, London SE1 7EH, UK.
² First Department of Internal Medicine, Center for Diabetes, Metabolism and Endocrinology, AHEPA University Hospital, 546 36 Thessaloniki, Greece.
³ Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London (UCL), London NW3 2QG, UK.
⁴ Guy's & St Thomas' NHS Foundation Trust, London SE1 7EH, UK.
⁵ 2nd Cardiology Clinic East Slovak Institute for CV Disease and Faculty of Medicine PJ Safarik University, 04011 Kosice, Slovakia.
⁶ Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, 93-338 Lodz, Poland.
⁷ Polish Mother's Memorial Hospital Research Institute (PMMHRI), 93-338 Lodz, Poland.
⁸ Cardiovascular Research Centre, University of Zielona Gora, 65-046 Zielona Gora, Poland.

Abstract

Background: There is a lack of evidence regarding the link between apolipoproteins and cancer mortality. By using two nationally representative samples of US adults, we prospectively evaluated the associations between apolipoprotein B (apoB) levels and apoB/apoA-I ratio with cancer mortality. We also examined the role of C-reactive protein (CRP) in these associations.

Materials and methods: Adults aged ≥20 years, enrolled in the 3rd National Health and Nutrition Examination Survey (NHANES III, 1988-1994) and continuous NHANES (2005-2010), and followed up to 31 December 2011, were included in the analysis. Multiple Cox regressions were applied to evaluate the associations between the variables of interest and cancer mortality.

Results: Overall, 7695 participants were included (mean age: 49.2 years; 50.4% men, median follow-up: 19.1 years). In the fully adjusted model, participants in the highest quartile (Q4) of apoB/apoA-I had a significantly greater risk for cancer mortality (hazard ratio (HR): 1.40; 95% confidence interval (CI): 1.25-1.93) compared with those in the first quartile (Q1). In the same model, a positive and significant association between apoB levels and cancer mortality was observed for individuals in Q3 (HR: 1.12; 95% CI: 1.09-1.16) and Q4 (HR: 1.17; 95% CI: 1.09-1.25) compared with those in Q1. When CRP levels were added in the analysis, the apoB/apoA-I ratio, but not apoB levels, remained significantly related to cancer mortality (Q4 = HR: 1.17; 95% CI: 1.09-1.25). In contrast, CRP levels were not able to predict cancer death after correction for apoB/apoA-I ratio.

Conclusions: In a large representative sample of the US adult population, the apoB/apoA-I ratio and apoB levels significantly predicted cancer mortality, independently of several cardiometabolic risk factors. The predictive value of apoB/apoA-I, but not apoB levels, remained significant after taking into account CRP, whereas CRP was not associated with cancer mortality after adjustment for apoB/apoA-I ratio. If further evidence supports our findings, apoA-I and apoB measurements could be considered in general healthcare policies.

Keywords: C-reactive protein; NHANES; apolipoprotein A-I; apolipoprotein B; cancer mortality.