The associations of levels of apolipoprotein A1 (ApoA1) and apolipoprotein B and ApoB/A1 ratio and risk of a first stroke have not been reliably documented. We performed a meta-analysis to summarize the relationships and confirmed them in a case–control study. We identified relevant publications in PubMed and Embase databases up to June 1, 2015. A Dersimonian-Laird random effects model was used to compute summary relative risks (RRs) and 95 % confidence intervals (CIs). A case–control study was conducted in a southern Chinese population. We included 8 cohort and 4 case–control studies (222,774 subjects; 10,032 first stroke events) in the meta-analysis. Reduced ApoA1 level and increased ApoB level and ApoB/A1 ratio was associated with a first stroke in cohort studies (RR 0.86 [95 % CI 0.79–0.94], 1.66 [1.62–1.69], and 1.66 [1.63–1.70], respectively) and reduced ApoA1 level and increased ApoB/A1 ratio in case–control studies (0.68 [0.47–0.99] and 1.76 [1.50–2.06], respectively). When stratified by stroke type in cohort studies, the RR for ischemic stroke was 0.83 (0.76–0.90), 1.36 (1.32–1.40), and 1.38 (1.35–1.42) for the 3 factors, respectively. In our case–control study (1013 cases; 1029 controls), the OR for a first ischemic stroke was 0.83 (0.74–0.92), 1.33 (1.18–1.48) and 2.10 (1.76–2.51), respectively, with increased ApoA1 level associated with hemorrhagic stroke (1.37 [1.06–1.78]). Meta-analysis suggests that reduced ApoA1 level and increased ApoB level and ApoB/A1 ratio are risk factors for a first ischemic but not hemorrhagic stroke. Elevated ApoA1 level may be a risk factor for a first hemorrhagic stroke.
Apolipoproteins Stroke Meta-analysis Case–control study Risk factor
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This study was supported by the Science and Technology Plans of Guangdong Province (2013B021800264). We thank the staff envolved in this study in the communities of Shantou. We also thank Dr. Stanley Lin and Dr. Laura Smales for English language editing.
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflict of interest.
Statement of human rights
The studies have been approved by the Second Affiliated Hospital of Shantou University Medical College and Chaonan Minsheng Hospital ethics committee and have been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
This study was funded by the Science and Technology Plans of Guangdong Province (2013B021800264).
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Second Affiliated Hospital of Shantou University Medical College and Chaonan Minsheng Hospital and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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