Increased Apolipoprotein B/Apolipoprotein A-I Ratio Is Associated With Decline in Lung Function in Healthy Individuals: The Kangbuk Samsung Health Study

Abstract

Background: Lung dysfunction and high apolipoprotein B/apolipoprotein A-I (apoB/apoA-I) ratio are both recognized risk factors for cardiovascular disease. However, few studies have examined the association between the apoB/ApoA-I ratio and lung function. Therefore, we investigated whether this ratio is associated with decreased lung function in a large healthy cohort.

Methods: We performed a cohort study on 68,418 healthy Koreans (34,797 males, mean age: 38.1 years) who underwent a health examination in 2019. ApoB/apoA-I ratio was categorized into quartiles. Spirometric values at the fifth percentile in our population were considered the lower limit of normal (LLN), which was used to define lung function impairment. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs), using the lowest quartile as the reference, were estimated to determine lung function impairment.

Results: Mean apoB/apoA-I ratio was 0.67 ± 0.21. Subjects with the highest quartile of this ratio had the lowest predicted forced expiratory volume in one second (FEV₁%) and forced vital capacity (FVC%) after controlling for covariates (P < 0.001). However, FEV₁/FVC ratio was not significantly different among the four quartiles (P = 0.059). Compared with the lowest quartile (Q1, reference), the aORs (95% CI) for FEV₁% < LLN across increasing quartiles (from Q2 to Q4) were 1.216 (1.094-1.351), 1.293 (1.156-1.448), and 1.481 (1.311-1.672) (P for trend < 0.001), respectively. Similarly, the aORs for FVC% < LLN compared with the reference were 1.212 (1.090-1.348), 1.283 (1.147-1.436), and 1.502 (1.331-1.695) with increasing quartiles (P for trend < 0.001). However, the aORs for FEV₁/FVC < LLN were not significantly different among groups (P for trend = 0.273).

Conclusion: High apoB/apoA-I ratio was associated with decreased lung function. However, longitudinal follow-up studies are required to validate our findings.

Keywords: ApoB/A-I Ratio; Apolipoprotein A-I; Apolipoprotein B; Healthy Population; Lung Function; Spirometry.

Fig. 1. Flow chart of study participants. Details of comorbidities were unavailable because the medical history questionnaire only required yes/no responses. As some individuals had more than one exclusion criterion, 73,795 participants were ultimately included in the analysis.

COPD = chronic obstructive pulmonary disease, BA = bronchial asthma, HBsAg = hepatitis B virus surface antigen, HCV-Ab = hepatitis C virus antibody, MS = metabolic syndrome, HDL = high-density lipoprotein.