From lipid dysbalance to cardiorenal decompensation: apoB/ApoA1 ratio is associated with acute cardiorenal injury in CAD patients

Background Cardiovascular and renal diseases exhibit a close bidirectional interaction, which often leads to the development of cardio-renal syndrome (CRS)—a clinical condition in which cardiac dysfunction further aggravates renal injury. Type I CRS is characterized by acute kidney injury secondary to acute heart failure, and this sub-type is closely related to elevated morbidity and mortality in patients with coronary artery disease (CAD). Despite the availability of traditional biomarkers, there is an unmet need for more sensitive indicators to identify high-risk patients for Type I CRS in CAD patients. The apolipoprotein B (ApoB)/apolipoprotein A1 (ApoA1) ratio has emerged as a promising predictor of cardiovascular risk, yet its role in CRS remains unclear. Objective This study aimed to evaluate the association between the ApoB/ApoA1 ratio and Type I CRS in patients with CAD, and to assess its value as a biomarker for identifying high-risk patients. Methods A retrospective cohort study was carried out on 269 CAD patients complicated with heart failure who were hospitalized in our hospital from 2022 to 2024. According to the estimated glomerular filtration rate (eGFR) results, the enrolled patients were divided into two subgroups: the simple heart failure (SHF) group and the type I CRS group. Data on demographics, clinical history, biochemical measurements, echocardiographic and coronary angiography assessments, and renal function were collected. A multivariable logistic regression model was used to assess the association between the ApoB/ApoA1 ratio and CRS, adjusting for potential confounders. Correlation analyses were performed to explore the relationships between key variables and the occurrence of type I CRS. A multivariable logistic regression model was used to assess the association between the ApoB/ApoA1 ratio and CRS. Furthermore, a receiver operating characteristic (ROC) curve was constructed to evaluate the predictive accuracy of the ApoB/ApoA1 ratio for type I CRS. Results A total of 269 patients were enrolled. Significant differences were observed between the simple heart failure (SHF) group and the CRS group in terms of age, history of diabetes mellitus, levels of triglycerides (TG), apolipoprotein A1 (apo-A1), apolipoprotein B (apo-B), ApoB/ApoA1 ratio, and serum creatinine (Scr). Patients in the CRS group were older, had a higher proportion of diabetes mellitus, higher levels of TG, apo-B, and Scr, a higher ApoB/ApoA1 ratio, but lower levels of apo-A1 compared to the SHF group. Multivariable logistic regression analysis identified age and the ApoB/ApoA1 ratio as independent risk factors for CRS. The receiver operating characteristic (ROC) curve analysis showed that the ApoB/ApoA1 ratio had a moderate level of predictive accuracy for Type I CRS, with an area under the curve (AUC) of 0.782. Conclusion The ApoB/ApoA1 ratio is moderately associated with the risk of developing Type I CRS in patients with CAD. This ratio could serve as a clinically relevant biomarker for early identification of in-hospital Type I CRS risk in CAD patients with acute heart failure, potentially aiding in the implementation of early and targeted interventions to improve patient outcomes.