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Association of low serum levels of apolipoprotein A-I with adverse outcomes in patients with nonischemic heart failure.
Iwaoka, M, Obata, JE, Abe, M, Nakamura, T, Kitta, Y, Kodama, Y, Kawabata, K, Takano, H, Fujioka, D, Saito, Y, et al
Journal of cardiac failure. 2007;(4):247-53
Abstract
BACKGROUND There is extensive evidence that low serum levels of high-density lipoprotein (HDL) cholesterol and apolipoprotein A-I (apoA-I) predict a worse prognosis in patients with ischemic heart disease. This study examined whether apoA-I levels may also provide prognostic information in patients with nonischemic heart failure. METHODS AND RESULTS A prospective follow-up study was performed in 117 consecutive patients with nonischemic heart failure for a period of < or = 36 months until the first occurrence of 1 of the following clinical events: all-cause death, cardiac death, and hospitalization with worsening heart failure. Serum levels of apoA-I were measured by immunoturbidimetry. A clinical event occurred during follow-up in 28 (24%) patients. A multivariate Cox proportional hazards analysis showed that lower apoA-I levels (< 103 mg/dL: determined by a receiver-operating characteristic analysis) were significantly associated with an adverse outcome that was independent of creatinine clearance, HDL cholesterol levels, and brain natriuretic peptide levels. ApoA-I was inversely correlated with levels of C-reactive protein and fibrinogen, known inflammatory predictors of poor prognosis in heart failure. CONCLUSIONS Low levels of apoA-I are independently associated with an adverse prognosis in patients with nonischemic heart failure. ApoA-I may play a beneficial role in nonischemic heart failure partly through an anti-inflammatory action.