Association between apolipoprotein B/A1 ratio with heart failure severity in HFrEF, HFmrEF, and HFpEF

Apolipoprotein (apo) B and apo A1 are major protein components of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) particles, which are closely linked to lipid metabolism, atherosclerosis, and endothelial function. We investigated whether the circulating apoB/A1 ratio could serve as a potential metabolic risk factor for the severity of chronic heart failure (HF) with multiple etiologies. Serum levels of apo B and apo A1 were measured in 1285 consecutive patients with clinical symptoms of chronic HF and 1392 healthy controls. Left ventricular (LV) ejection fraction (EF) and the ratio of early diastolic mitral inflow to mitral annular tissue velocities (E/e’) were determined by two-dimensional echocardiography and Doppler flow imaging using the standard biplane technique. The relationship between the apoB/A1 ratio and the classification and etiology of HF was examined by logistic regression analysis. The apoB/A1 ratio gradually increased from controls, HF with preserved EF (HFpEF) and HF with mildly reduced EF (HFmrEF) to HF with reduced EF (HFrEF) ( P < 0.001). In all HF patients, the serum apoB/A1 ratio was elevated with decreased EF, but with increased E/e’ (all P < 0.001). Further analysis revealed that the apoB/A1 ratio was significantly associated with HF caused by ischemic heart disease (IHD) or hypertensive heart disease (HHD) (all P < 0.001). After adjustment for conventional risk factors, HF classification according to LVEF was correlated with a higher apoB/A1 ratio in HF patients with IHD [odds ratio (OR), 1.639; 95% confidence interval (CI), 1.256–2.139; P < 0.001] or with HHD (OR, 2.096; 95% CI, 1.059–4.149; P = 0.034), respectively. In patients with chronic HF, an increased circulating apoB/A1 ratio was associated with worsened LV dysfunction, especially in those with IHD or HHD.