High apolipoprotein AI concentrations are associated with lower mortality and myocardial infarction five years after coronary artery bypass graft surgery
a Departments
of Cardiology, Freeman Hospital and Royal Victoria Infirmary, Queen
Victoria Road, Newcastle upon Tyne NE1 4LP, UK, b Division of Public Health and Primary Care, The
University of Oxford, Oxford, UK
Correspondence to: Dr Skinner. email: jane{at}enaj.demon.co.uk
Accepted for publication 30 November 1998
OBJECTIVE
To examine
mortality and myocardial infarction five years after coronary artery
bypass graft (CABG) surgery and the association with different lipid
fractions and haemostatic, glycaemic, and demographic risk factors.
SETTINGA regional
cardiothoracic centre, Freeman Hospital, and the University Clinical
Investigation Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
DESIGN353 consecutive
patients (297 male, mean age 57.2 years) undergoing first time CABG for
stable angina were recruited to a prospective cohort study and studied
to five years.
MAIN OUTCOME
MEASURESAll cause mortality, late cardiac
mortality (beyond 30 days) alone and in combination with non-fatal
myocardial infarction. Risk factor assessments before operation and 3, 6, 12, 24, and 60 months after surgery. For each laboratory variable a
weighted mean for the period of exposure was calculated from the
concentration at each time interval and the time between measurements.
The distribution was divided into tertiles.
RESULTS41 patients
died (16 late cardiac deaths) and eight had a myocardial infarct. An
adverse outcome occurred more frequently in the lower tertile of
weighted apolipoprotein AI compared with the upper tertile. An adverse
outcome was also more common in patients in the upper tertile of
weighted total white blood cell count and less consistently so in
patients in the upper tertile of the haemostatic covariates, factor
VIIc and factor VIIIc. There was no association with other lipid
fractions except for total mortality and apolipoprotein B (owing to low
levels in five patients with carcinoma).
CONCLUSIONSLow
apolipoprotein AI concentrations, but no other markers of an adverse
lipid profile, were associated with mortality and myocardial infarction
five years after CABG. Apolipoprotein AI is associated with
paraoxonase, an enzyme located on high density lipoprotein, which may
limit the oxidation of low density lipoprotein. An association between
outcome and other covariates such as white cell count provides a
credible pointer to inflammation mediating a component of
cardiovascular risk.
Keywords: coronary artery bypass graft surgery; mortality; myocardial infarction; apolipoprotein AI
© 1999 by Heart
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