Atherogenic Index of Plasma as Predictor for Cardiovascular Events and Cardiometabolic Diseases:Findings from the PAMELA Study

Introduction: The Atherogenic Index of Plasma (AIP), ratio between triglycerides and high-density lipoprotein cholesterol, has been associated with cardiovascular (CV) events, metabolic syndrome and hypertension (HT)-related vascular organ damage. However, the majority of the published studies suffer from important limitations, such as the cross-sectional or retrospective nature and the performance in selected Asian populations only. Aim: We performed a data analysis in the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study, examining longitudinally the relationships between AIP, diabetes mellitus (DM), HT and left ventricular hypertrophy (LVH) in a western European general population. Methods: At the study entry baseline data were collected in 2035 subjects, while longitudinal data were obtained in 1412 subjects examined for a median follow-up time lasting 10.7 years. Results: 50.6% of the subjects were males, aged 50.9 ± 13.7 (mean ± SD) yrs. During the follow-up AIP did not significantly change (from − 0.11 ± 0.3 to − 0.12 ± 0.29 a.u., P = NS), while systolic BP and plasma glucose significantly increased, with a significant relationship with HT, DM and LVH development (P < 0.0001). At multivariable analysis, AIP significantly and independently predicted the above-mentioned outcomes, with the exception of HT development based on home BP. The same significant association was detected for fatal and non-fatal CV events. Conclusions: These data provide evidence that in a general European population characterized by a low CV risk AIP significantly and independently predicts HT, DM and LVH development and is significantly associated with the composite outcome of CV morbidity and mortality.