tH e u tility o F Apolipoprotein A1, r emn Ant l ipoproteins, And t He Apolipoprotein A1 r emn Ant rA tio to t He incidence o F coron Ary He Art dise Ase in A p rim Ary p revention co Hort o F AFric An Americ Ans o ver All And by s ex: tH e jAckson He Art s tudy

background: Dyslipidemia plays a significant role in the progression of cardiovascular (CV) disease. The apolipoprotein (apo) A1 remnant ratio (apo A1/[VLDL3-C + IDL-C]) has recently been shown to be a strong predictor of death/MI risk among women >50 years undergoing angiography. However, whether this ratio is associated with CHD risk among other populations is unknown. m ethods: Participants (N=4,722) of the Jackson Heart with lipoprotein measurements by the Vertical Auto Profile method (Atherotech, Birmingham, AL) were studied. Cox hazard regression analysis, adjusted by standard CV risk factors, was utilized to determine associations of lipoproteins with CHD incidence. r esults: Patients averaged 54.2±12.8 years and 64% (n=3,018) were female. Those with new-onset CHD were older, diabetic, had less education, smokers, and more lipid-lowering medication use. They had significantly higher remnant lipoprotein levels and a lower apo A1 remnant ratio. After adjustment, the apo A1 remnant was strongly associated with CHD incidence (Table). This association appears to be driven by the IDL-C denominator. Standard lipids were not associated with CHD incidence. conclusions: This study found the apo A1 remnant ratio to be strongly associated with CHD incidence among both genders. This ratio appears to better stratify risk than standard lipids, apo A1, and apo B among a primary prevention cohort of African Americans. Its utility requires further study as a target of lipoprotein management for risk reduction.