... MD, PhD; Kurt Huber, MD; Michael Hanna, MD; Renato D. Lopes, MD, MHS, ...... Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D. ... Popescu BA, Schotten U, Van Putte B, Vardas P, Agewall S, Camm J, Baron.
ORIGINAL RESEARCH
Dyslipidemia and Risk of Cardiovascular Events in Patients With Atrial Fibrillation Treated With Oral Anticoagulation Therapy: Insights From the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) Trial Tymon Pol, MD; Claes Held, MD, PhD; Johan Westerbergh, MSc; Johan Lindb€ack, MSc; John H. Alexander, MD, MHS; Marco Alings, MD, PhD; Cetin Erol, MD; Shinya Goto, MD, PhD; Sigrun Halvorsen, MD, PhD; Kurt Huber, MD; Michael Hanna, MD; Renato D. Lopes, MD, MHS, PhD; Witold Ruzyllo, MD; Christopher B. Granger, MD; Ziad Hijazi, MD, PhD
Background-—Dyslipidemia is a major risk factor for cardiovascular events. The prognostic importance of lipoproteins in patients with atrial fibrillation is not well understood. We aimed to explore the association between apolipoprotein A1 (ApoA1) and B (ApoB) and cardiovascular events in patients with atrial fibrillation receiving oral anticoagulation. Methods and Results-—Using data from the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial, ApoA1 and ApoB plasma levels were measured at baseline in 14 884 atrial fibrillation patients. Median length of follow-up was 1.9 years. Relationships between continuous levels of ApoA1 and ApoB and clinical outcomes were evaluated using Cox models adjusted for cardiovascular risk factors, medication including statins, and cardiovascular biomarkers. A composite ischemic outcome (ischemic stroke, systemic embolism, myocardial infarction, and cardiovascular death) was used as the primary end point. Median (25th, 75th) ApoA1 and ApoB levels were 1.10 (0.93, 1.30) and 0.70 g/L (0.55, 0.85), respectively. In adjusted analyses, higher levels of ApoA1 were independently associated with a lower risk of the composite ischemic outcome (hazard ratio, 0.81; P0.94 to 1.1
>1.1 to 1.3
>1.3
n
3823
4521
3728
2812
Age, y median (Q1, Q3)
70.0 (62.0, 76.0)
69.0 (62.0, 76.0)
70.0 (63.0, 76.0)
71.0 (64.0, 76.0)
