Apolipoprotein B/Apolipoprotein A-I Ratio Is a Better Predictor of Cancer Mortality Compared with C-Reactive Protein: Results from Two Multi-Ethnic US Populations

Background: There is a lack of evidence regarding the link between apolipoproteins and cancer mortality. By using two nationally representative samples of US adults, we prospectively evaluated the associations between apolipoprotein B (apoB) levels and apoB/apoA-I ratio with cancer mortality. We also examined the role of C-reactive protein (CRP) in these associations. Materials and Methods: Adults aged ≥20 years, enrolled in the 3rd National Health and Nutrition Examination Survey (NHANES III, 1988–1994) and continuous NHANES (2005–2010), and followed up to 31 December 2011, were included in the analysis. Multiple Cox regressions were applied to evaluate the associations between the variables of interest and cancer mortality. Results: Overall, 7695 participants were included (mean age: 49.2 years; 50.4% men, median follow-up: 19.1 years). In the fully adjusted 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). In the same model, a positive and significant association between apoB levels and cancer mortality was observed for individuals in 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 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. 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 healthcare policies.

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

European Heart Journal ◽

10.1093/eurheartj/ehz748.0089 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Mazidi ◽

D P Mikhailidis ◽

N Katsiki ◽

A Sniderman ◽

M Banach

Keyword(s):

Cancer Mortality ◽

Adult Population ◽

Educational Status ◽

Cancer Death ◽

C Reactive Protein ◽

Reactive Protein ◽

Apolipoprotein A ◽

Diabetes Model ◽

Income Ratio ◽

Nationally Representative

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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Social isolation, inflammation, and cancer mortality from the National Health and Nutrition Examination Survey - a study of 3,360 women

BMC Public Health ◽

10.1186/s12889-021-11352-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Alexander Koh-Bell ◽

Joshua Chan ◽

Amandeep K. Mann ◽

Daniel S. Kapp

Keyword(s):

Physical Activity ◽

Social Isolation ◽

National Health ◽

Low Income ◽

Cancer Mortality ◽

Nutrition Examination Survey ◽

C Reactive Protein ◽

Reactive Protein ◽

Health And Nutrition ◽

Markers Of Inflammation

Abstract Background This study evaluates the role of social isolation on inflammation and cancer mortality among women. Methods Data were abstracted from the U.S. National Health and Nutrition Examination Survey from 1988 to 1994. The Social Network Index was used to assess participants’ degree of social isolation. C-reactive protein and fibrinogen levels were included as markers of inflammation. We used the National Death Index to identify causes and dates of mortality. Chi-square and multivariable Cox regressions were employed for statistical analyses. Results Of 3360 women (median age: 54 years), the most isolated, very isolated, somewhat isolated, and not isolated comprised 14.5, 30.2, 37.1, and 18.2% of the sample, respectively. The most isolated participants were more likely to have low income (56.8% vs 12.2%, p < 0.001), have fewer years of education (40.8% vs 12.3%; p < 0.001), have low physical activity (27.3% vs 14.7%; p < 0.003), be obese (32.5% vs 24.4%; p = 0.02), and be current smokers (34.2% vs 10.3%; p < 0.001) compared to the not isolated ones. Mean fibrinogen levels increased with degree of social isolation (p = 0.003), but C-reactive protein showed no association (p = 0.52). Kaplan-Meier estimates indicated higher cancer mortality rates among participants with elevated fibrinogen levels, though not with statistical significance (p = 0.08). Furthermore, there was no association between social isolation and cancer mortality (p = 0.54). On multivariate analysis, obesity (HR = 1.56; 95% CI: 1.11–2.18), higher education (HR = 1.36; 95% CI: 1.01–1.83), and smoking (HR = 4.42, 95% CI: 2.84–6.88) were independent predictors for cancer mortality, while high physical activity predicted for lower mortality from cancer (HR = 0.67, 95% CI: 0.51–0.87). However, social isolation was not a predictor. Conclusion Social isolation among women was associated with an increased level of fibrinogen, but not associated with cancer mortality. The relationship between inflammation and cancer mortality warrants further investigation.

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Association of C-Reactive Protein with Surrogate Measures of Insulin Resistance among Nondiabetic US Adults: Findings from National Health and Nutrition Examination Survey 1999–2002

Clinical Chemistry ◽

10.1373/clinchem.2007.088930 ◽

2007 ◽

Vol 53 (12) ◽

pp. 2152-2159 ◽

Cited By ~ 21

Author(s):

Yuan-Xiang Meng ◽

Earl S Ford ◽

Chaoyang Li ◽

Alexander Quarshie ◽

Ahmad M Al-Mahmoud ◽

...

Keyword(s):

Insulin Resistance ◽

Body Mass Index ◽

Odds Ratio ◽

Representative Sample ◽

Nutrition Examination Survey ◽

C Reactive Protein ◽

Reactive Protein ◽

Health And Nutrition ◽

Nationally Representative ◽

Surrogate Measures

Abstract Background: Increased C-reactive protein (CRP) concentration and insulin resistance (IR) are associated with increased rates of adverse cardiovascular events. We sought to examine the relationship of CRP with surrogate measures of IR among nondiabetic adults in the US. Methods: We conducted analyses using data from the National Health and Nutrition Examination Survey 1999–2002. We analyzed a nationally representative sample of 2514 men and nonpregnant women age ≥20 years who were non-Hispanic white, non-Hispanic black, or Mexican American. Results: After adjustment for age, sex, race/ethnicity, smoking status, systolic blood pressure, and serum concentrations of HDL cholesterol, LDL cholesterol, and triglyceride, CRP was significantly associated with 10 IR measures (all P values <0.01). The strength of the association attenuated after further adjustment for waist circumference (change in adjusted regression coefficients ranging from 60.0% to 75.1%). The association of CRP with each IR surrogate was similar (standardized regression coefficient ranges from 0.06 to 0.09). The association of CRP (>3 vs <1 mg/L) with the homeostasis model for assessment of IR (≥75th vs <75th percentile) was statistically significant among people with a body mass index ≥30 kg/m2 (odds ratio, 2.6; 95% CI, 1.3–5.1) or with a body mass index <25 kg/m2 (odds ratio, 2.5; 95% CI, 1.5–4.2). Conclusions: CRP was significantly associated with the surrogate measures of IR among nondiabetic adults. Obesity may play an important role in the association of CRP with IR in this nationally representative sample.

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Social Isolation, Inflammation, and Cancer Mortality from the National Health and Nutrition Examination Survey - A Study of 3,446 Women

10.21203/rs.3.rs-275389/v1 ◽

2021 ◽

Author(s):

Alexander Koh-Bell ◽

Joshua Chan ◽

Amandeep K. Mann ◽

Daniel S. Kapp

Keyword(s):

Physical Activity ◽

Social Isolation ◽

National Health ◽

Low Income ◽

Cancer Mortality ◽

Nutrition Examination Survey ◽

C Reactive Protein ◽

Reactive Protein ◽

Health And Nutrition ◽

Markers Of Inflammation

Abstract Background To evaluate the relationships of social isolation, inflammatory biomarkers, and cancer mortality among women.Methods Data were abstracted from the U.S. National Health and Nutrition Examination Survey from 1988-1994. The Social Network Index was used to assess participants’ degree of social isolation. C-reactive protein and fibrinogen levels were included as markers of inflammation. We used the National Death Index to identify causes and dates of mortality. Chi-square and multivariable Cox regressions were employed for statistical analyses.Results Of 3,446 women (median age: 55 years), the most isolated, very isolated, somewhat isolated, and not isolated comprised 14.5%, 30.3%, 37.0%, and 18.2% of the sample, respectively. The most isolated participants were more likely to have low income (57.1% vs 12.2 %, p<0.001), have fewer years of education (40.6% vs 12.2%; p<0.001), have low physical activity (27.3% vs 14.6%; p<0.003), be obese (32.3% vs 24.2%; p=0.02), and be current smokers (33.8% vs 10.2 %; p<0.001) compared to the not isolated ones. Mean fibrinogen levels increased with degree of social isolation (p=0.02), but C-reactive protein showed no association (p=0.58). Kaplan-Meier estimates indicated higher cancer mortality rates among participants with elevated fibrinogen levels, though not statistically significant (p=0.07). Furthermore, there was no correlation between social isolation and cancer mortality (p=0.55). On multivariate analysis, obesity (HR=1.39; 95% CI: 1.05-1.83; p=0.02) and lower education (HR=1.48; 95% CI: 1.04-2.11; p=0.03) were independent predictors for cancer mortality, while high physical activity predicted for lower mortality from cancer (HR=0.67, 95% CI: 0.49-0.91; p=0.01). However, social isolation was not a predictor (p=0.88).Conclusion Social isolation among women was associated with an increased level of fibrinogen, but not associated with cancer mortality. The relationship between inflammation and cancer mortality warrants further investigation.

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