Association Between the Atherogenic Index of Plasma and Multiple Recurrent Major Atherosclerotic Cardiovascular Events in Patients with Coronary artery disease

Background: Patients with established atherosclerotic cardiovascular disease (ASCVD) remain at high risk of recurrent events despite guideline-directed low-density lipoprotein cholesterol (LDL-C)-lowering therapy. The atherogenic index of plasma (AIP) integrates pro- and anti-atherogenic lipid information, but its association with multiple recurrent major ASCVD (mASCVD) events in coronary artery disease (CAD) is unclear. Hypothesis: Higher AIP is independently associated with multiple recurrent mASCVD events in patients with CAD who have undergone coronary revascularization. Methods: We retrospectively studied 284 patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention who had ≥2 severe coronary events and/or ≥1 severe coronary event plus ischemic stroke or symptomatic peripheral arterial disease (recurrent mASCVD group, R-mASCVD). As controls, 292 outpatients with stable CAD (SCAD) had a history of ACS treated with revascularization and remained free of mASCVD events for ≥5 years. Clinical characteristics, laboratory indices, lipid parameters, and AIP were recorded. Logistic regression identified independent predictors of multiple recurrent mASCVD events. Receiver operating characteristic (ROC) analysis evaluated the discriminatory value of AIP. Results: Compared with SCAD patients, those with R-mASCVD had longer ASCVD duration, more diabetes, more extensive coronary revascularization, lower left ventricular ejection fraction, and lower estimated glomerular filtration rate (all P < 0.05). LDL-C levels were similar between groups, whereas triglycerides and small dense LDL-C were higher, HDL-C was lower, and AIP was significantly higher in the R-mASCVD group ( P < 0.01). In multivariable analysis, ASCVD duration, AIP (odds ratio 1.206 per 0.1 increase; 95% confidence interval 1.098-1.333), and eGFR were independent predictors of multiple recurrent mASCVD events. AIP yielded an area under the ROC curve of 0.644 (95% confidence interval 0.580-0.708; P < 0.001). Conclusions: Elevated AIP is independently associated with multiple recurrent major ASCVD events in patients with CAD. AIP may be used as an simple and effective predictor of recurrent mASCVD events in this population.