Apolipoprotein A2 as Protection Against Increased Mortality After Aortic Aneurysm Repair

Abstract

The prognosis of patients with aortic aneurysm (AA) and cardiovascular comorbidities remains suboptimal compared to that of the general population, highlighting the need for reliable mortality biomarkers. Apolipoprotein A2 (ApoA2) is a structural and functional component of high-density lipoprotein cholesterol (HDL-C), but its relevance to all-cause mortality remains unclear. Therefore, we investigated the prognostic value of ApoA2 in patients with AA after surgical repair. ApoA2 levels were measured in 203 consecutive patients with AA who were successfully treated with surgical repair. The primary focus was the predictive value of ApoA2 levels for mortality events. During a median follow-up of 3.5 years, mortality events were observed in 32 patients (15.8 %). Patients with mortality events had lower ApoA2 levels than the survivors [22.0 (19.0, 25.0) mg/dL versus 25.0 (22.0, 29.0) mg/dL, P < 0.001]. ApoA2 was inversely correlated with age, BNP, C-reactive protein (CRP), and fibrinogen levels and positively correlated with eGFR. Multivariate Cox analysis identified ApoA2 (HR 0.92, 95% CI 0.86-0.99), eGFR < 60 mL/minute/1.73 m² (HR 3.49, 95% CI 1.49-8.20), COPD (HR 2.63, 95% CI, 1.07-6.49), and thoracic AA (HR 2.54, 95% CI 1.25-5.18) as independent mortality predictors. Moreover, the addition of ApoA2 levels significantly improved the discriminative ability of the baseline risk factors in predicting mortality (AUC 0.79 versus 0.73, P = 0.04). Therefore, ApoA2 is a potential biomarker for predicting long-term mortality in patients with AA following surgical repair, and may contribute to improved risk stratification in this high-risk population.