Association of apolipoprotein levels with all-cause and cardiovascular mortality

Aims Research has shown that apolipoproteins (Apos) are potential indicators of heart health and death. We investigated the associations of Apo levels with all-cause and cardiovascular mortality.Methods and results We systematically searched the Cochrane Library, PubMed, and Web of Science for English language studies up to 28 November 2022. We used Stata 17.0 to summarize the estimated effects with 95% confidence intervals (CIs). We also conducted subgroup analyses according to study location, year of publication, individual age, follow-up years, and sample size. Moreover, we performed a sensitivity analysis to evaluate bias in our study. This study included 23 studies with 152 854 individuals in total. The level of ApoA was negatively related to cardiovascular mortality [odds ratio (OR) = 0.69, 95% CI = 0.52-0.93]. An increased ratio of ApoB/A1 was a risk factor for cardiovascular mortality (OR = 2.13, 95% CI = 1.48-3.07) and all-cause mortality (OR = 2.05, 95% CI = 1.52-2.77). The level of ApoB was positively related to cardiovascular mortality (OR = 1.12, 95% CI = 0.85-1.47), but the difference was not statistically significant. However, the associations between ApoB or ApoA1 and all-cause mortality were not obvious. Our subgroup analyses showed that the location, year of publication, individual age, and follow-up years of the studies affected the heterogeneity of our study to varying degrees. The sensitivity analysis showed that our results were almost robust, apart from excluding the article by Nomikos (OR = 0.77, 95% CI = 0.65-0.92) and Zeng (OR = 0.77, 95% CI = 0.65-0.91), when investigating the relationship between ApoA1 and all-cause mortality.Conclusion In this study, we found that Apo levels were linked to cardiovascular and all-cause mortality. Our study strengthens the evidence on the association between the level of Apos and cardiac health and may provide ideas for regulating the level of Apos to promote public health. This study supports the association between apolipoproteins and cardiac health by conducting an analysis of the impact of ApoA1 and ApoB and the ratio of ApoB/A1 on cardiovascular mortality and all-cause mortality. These findings may provide some ideas for promoting public health.