Abdominal obesity with hypertriglyceridaemia, lipoprotein(a) and apolipoprotein A-I determine marked cardiometabolic risk

作者：Onat Altan^*; Can Gunay; Ornek Ender; Sansoy Vedat; Aydin Mesut; Yuksel Husniye

来源：European Journal of Clinical Investigation, 2013, 43(11): 1129-1139.

DOI：10.1111/eci.12150

• Abdominal obesity
• coronary heart disease
• gender difference
• " hypertriglyceridemic waist' phenotype
• lipoprotein(a)-apolipoprotein A-I

Background Risks for coronary heart disease (CHD) and diabetes (T2DM) of the hypertriglyceridemic waist' phenotype (HtgW) warrant further investigation. We studied this issue and whether partial proinflammatory conversion of apolipoprotein (apo) A-I by lipoprotein(a) [Lp(a)] is a codeterminant.
Materials and Methods In a population-based prospective study, 1328 Turkish adults were analysed in four groups by the presence of abdominal obesity and elevated triglycerides (Htg).
Results LDL-cholesterol levels, significantly elevated in isolated Htg, were lower in HtgW, yet significantly higher apoB and complement C3 values existed in women with HtgW in whom also the lowest Lp(a) values prevailed. Lp(a) was linearly associated, more strongly in HtgW than in the remaining groups, with apoB and, in women inversely, with gamma-glutamyltransferase. Incident HtgW was predicted, not in men, but in women inversely by Lp(a) (OR 0 center dot 80 [95%CI 0 center dot 65; 0 center dot 97]), regardless of adjustment for relevant confounders. After adjustment for conventional risk factors, HtgW (OR 2 center dot 84) and high apoA-I/HDL-C ratio (OR 1 center dot 50) were significantly and additively associated with combined prevalent and incident CHD risk. High apoA-I and low HDL-cholesterol levels interacted therein in women. Type-2 diabetes was strongly predicted by HtgW, mediated in men by high apoA-I/HDL-C ratio.
Conclusion HtgW is associated with excess inflammatory markers, is predicted in women paradoxically by lower circulating Lp(a) and is associated in both sexes with marked excess cardiometabolic risk to which high apoA-I/HDL-C ratio contributes additively. These findings are consistent in women with apoA-I being oxidized via aggregation to Lp(a).

• 出版日期2013-11