In middle-aged and young populations, a high level of cumulative atherogenic index of plasma is associated with an increased risk of cardiovascular disease, independent of traditional risk factors and significant even among low-risk populations.
Key Findings
Results
Higher cumulative atherogenic index of plasma (AIP) quartile was associated with progressively increasing cardiovascular disease incidence density.
Study enrolled 35,212 participants under 60 years old from the Kailuan Study with complete physical examinations in 2006 and 2010.
Mean age was (45.4±8.3) years; 75.6% were male.
Incidence densities of new-onset cardiovascular disease from Q1 to Q4 groups were 3.08, 4.70, 5.55, and 7.23 per 1,000 person-years, respectively.
Mean follow-up was (11.5±2.0) years.
Results
Higher cumulative AIP quartiles were independently associated with significantly increased risk of cardiovascular disease compared to the lowest quartile.
Cox proportional hazard regression was used with adjustment for confounding factors.
Compared with Q1, HRs (95% CIs) for cardiovascular disease were: Q2: 1.27 (1.10–1.48), Q3: 1.33 (1.14–1.56), Q4: 1.43 (1.19–1.72), all P<0.05.
A statistically significant increasing trend in cardiovascular disease risk was observed across Q1 to Q4 (Ptrend<0.001).
Total cardiovascular disease events occurred in 2,075 cases (5.9%), including 390 myocardial infarctions (1.1%) and 1,725 strokes (4.9%).
Results
The association between cumulative AIP and cardiovascular disease was driven primarily by stroke, not myocardial infarction.
Stroke demonstrated a statistically significant increasing trend across AIP quartiles (Ptrend=0.002).
No statistically significant trend was observed for myocardial infarction (Ptrend=0.465).
Endpoint-specific Cox proportional hazards regression analyses were conducted for both subtypes.
Results
Significant multiplicative interactions were found between cumulative AIP and LDL-C levels, hypertension status, and diabetes status.
Subgroup analyses were stratified by hypertension status, diabetes status, and LDL-C levels (<3.4 mmol/L or ≥3.4 mmol/L).
All P values for interaction were <0.05.
In the low-risk population with LDL-C <3.4 mmol/L, the Q4 group had 48% higher cardiovascular disease risk compared to Q1 (P<0.05).
In non-hypertensive individuals, the Q4 group had 59% higher cardiovascular disease risk compared to Q1 (P<0.05).
In non-diabetic individuals, the Q4 group had 49% higher cardiovascular disease risk compared to Q1 (P<0.05).
Conclusions
The elevated cardiovascular disease risk associated with high cumulative AIP was independent of traditional risk factors and remained significant in low-risk subpopulations.
Risk remained significant after adjustment for confounding factors in Cox regression models.
Significant associations persisted in participants without hypertension, without diabetes, and with LDL-C <3.4 mmol/L.
These findings suggest cumulative AIP provides cardiovascular risk information beyond traditional risk stratification.
Chen Y, Liu H, Zhao H, Liu S, Wang M, Liu L, et al.. (2026). [Impact of cumulative atherogenic index of plasma exposure on the risk of new-onset cardiovascular disease in middle-aged and young populations].. Zhonghua xin xue guan bing za zhi. https://doi.org/10.3760/cma.j.cn112148-20251130-00838