Relation of Age, the Apolipoprotein BApolipoprotein A-I Ratio, and the Risk of Fatal Myocardial Infarction and Implications for the Primary Prevention of Cardiovascular Disease》.pdf

Relation of Age, the Apolipoprotein B/Apolipoprotein A-I Ratio, and the Risk of Fatal Myocardial Infarction and Implications for the Primary Prevention of Cardiovascular Disease a, b c d Allan D. Sniderman, MD *, Ingar Holme, PhD , Are Aastveit, PhD , Curt Furberg, MD, PhD , Goran Walldius, MDe,f, and Ingmar Jungner, MDg,h Age is by far the most powerful risk factor for cardiovascular disease. Moreover, the consequences of age are considered inevitable and irreversible. In this study, we examined whether age is, to a major degree, a modifiable risk factor. In the subjects in the Apoli- poprotein-related Mortality Risk (AMORIS) study, we show that fatal myocardial infarc- tion (MI) is uncommon in men before the sixth decade and in women before the seventh. In age-adjusted analyses, the risk of fatal MI increase successively with each decile of the apolipoprotein (apo) B/apoA-I ratio, confirming the importance of the balance of the atherogenic and antiatherogenic lipoproteins as a fundamental determinant of the likeli- hood of clinical events. We then determined the risk of fatal acute MI over time in the highest decile of the apoB/apoA-I ratio compared with the lowest decile. For the purposes of this analysis, we assume that all events in the lowest decile of the apoB/apoA-I ratio represent the nonmodifiable adverse effects of age. This assumption maximizes the irre- versible effects of age. Because the change in age is identical for the subjects in both decil