Physicians' Academy for Cardiovascular Education

Higher apolipoprotein A1 levels associated with lower risk of ischemic CV outcomes in atrial fibrillation

Dyslipidemia and Risk of Cardiovascular Events in Patients With Atrial Fibrillation Treated With Oral Anticoagulation Therapy: Insights From the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) Trial

Literature - Pol T, Held C, Westerbergh J, et al. - J Am Heart Assoc. 2018;7:e007444


Dyslipidemia is a major risk factor for adverse CV events like myocardial infarction (MI), but it’s role as a risk factor in patients with atrial fibrillation (AF) is not known [1,2]. In this sub-study of the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial, the association between the baseline concentrations of apolipoprotein A1 (ApoA1), the main protein component of high-density lipoprotein, and apolipoprotein B (ApoB), the main protein component of low-density lipoprotein, and clinical outcomes was evaluated in patients with AF treated with oral anticoagulation.

ARISTOTLE was a multicenter, double-blind, double-dummy, randomized, clinical trial which enrolled 18,201 patients with AF and at least 1 additional risk factor for stroke or systemic embolism, who were randomized to receive either warfarin or apixaban for stroke prevention in a 1:1 fashion [3,4]. The apolipoprotein biomarker sub-study cohort comprised of the first included 14,884 patients, and the median length of follow-up was 1.9 years.

The primary outcome of this biomarker analysis was a composite of ischemic stroke, systemic embolic event (SEE), MI, and CV death. Other evaluated outcomes were the individual components of the composite ischemic outcome, all-cause mortality and major bleeding, according to the International Society on Thrombosis and Haemostasis criteria [5].

Main results


In patients with AF treated with oral anticoagulation, higher levels of ApoA1 were independently associated with a lower risk of ischemic CV outcomes, including stroke/SEE and mortality. Higher ApoB levels were associated with higher rates of MI, and an unanticipated higher risk of all-cause mortality in those with lower ApoB levels. These findings suggest that treating dyslipidemia may be important for the improvement of CV outcomes in patients with AF.


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