2154Apolipoprotein B/apolipoprotein A-I ratio is comparable with C-reactive protein in predicting cancer mortality: results from two multi-ethnic US populations

Abstract Background There is a lack of evidence regarding the link between apolipoproteins and cancer mortality. Purpose By using two nationally representative samples of US adults, we prospectively evaluated the associations between apolipoprotein B (apoB) levels and apoB/apolipoprotein A-I (apoA-I) ratio with cancer mortality. We also examined the role of C-reactive protein (CRP) in these associations. Method Adults aged ≥20 years, enrolled in the Third National Health and Nutrition Examination Survey (NHANES-III, 1988–1994) and continuous NHANES (2005–2010), and followed up to December 31st 2011, were included in the present analysis. Multiple Cox regressionswere applied to evaluate the associations between the variables of interest and cancer mortality. Results Overall, 7,695 participants were included (mean age: 49.2 years; 50.4% men, median follow-up: 19.1 years). In the fully adjusted (for age, gender, race, poverty to income ratio, educational status, body mass index, alcohol and dietary intake, smoking, dyslipidemia, hypertension and diabetes) model, participants in the highest quartile (Q4) of apoB/apoA-I had a significantly greater risk for cancer mortality [hazard ratio (HR): 1.40, 95% confidence interval (CI): 1.25–1.93] compared with those in the first quartile (Q1) (Figure). In the same model, a positive and significant association between apoB levels and fatal cancer was observed for individuals in the Q3 (HR: 1.12, 95% CI: 1.09–1.16) and Q4 (HR: 1.17, 95% CI: 1.09–1.25) compared with those in the Q1. When CRP levels were added in the analysis, the apoB/apoA-I ratio, but not apoB levels, remained significantly related to cancer mortality (Q4= HR: 1.17, 95% CI 1.09–1.25). In contrast, CRP levels were not able to predict cancer death after correction for apoB/apoA-I ratio. Cancer death and quartiles of ApoB/ApoA1 Conclusions In a large representative sample of the US adult population, the apoB/apoA-I ratio and apoB levels significantly predicted cancer mortality, independently of several cardiometabolic risk factors. The predictive value of apoB/apoA-I, but not apoB levels, remained significant after taking into account CRP, whereas CRP was not associated with cancer mortality after adjustment for apoB/apoA-I ratio. If further evidence supports our findings, apoA-I and apoB measurements could be considered in general health-care policies. Acknowledgement/Funding None

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