Apolipoprotein A-I

Updated: Jul 07, 2021

Author: Georges Elhomsy, MD, ECNU, FACE; Chief Editor: Eric B Staros, MD

Reference Range

Apolipoprotein A-I (Apo-A1) is a structural and functional protein that constitutes approximately 70% of the protein in high density lipoprotein (HDL).

The reference ranges of Apo-A1 are as follows[1] :

Adult males: 75-160 mg/dL
Adult females: 80-175 mg/dL
Male newborns: 41-93 mg/dL
Female newborns: 38-106 mg/dL
Males (aged 6 months-4 years): 67-167 mg/dL
Females (aged 6 months-4 years): 60-148 mg/dL
Children aged 5-17 years: 83-151 mg/dL

Interpretation

Low apolipoprotein A-I level

A low Apo-A1 level indicates an increased risk of cardiovascular disease, especially in the presence of an elevated apolipoprotein B (Apo-B) level.[2, 3, 4, 5]

Other factors that are associated with low Apo A1 level include the following:

Chronic liver disease
Chronic kidney disease
Smoking
Obesity
High triglyceride level

High apolipoprotein A-I level

High Apo-A1 levels are associated with the following:

Pregnancy
Alcohol use
Spring and summer seasons[6]

Collection and Panels

Patient instructions: Overnight fasting (12-14 hours)

Collection tube: Lavender top (EDTA)

Unacceptable conditions: Hemolyzed specimens

Specimen preparation: Separate serum from cells as soon as possible or within 2 hours of collection and transfer to 1-mL serum transport tube

Storage/transport temperature: Refrigerated

Stability refrigerated: 8 days unfrozen; 3 months frozen

Panels: None

CPT Code: 82172

Background

Description

Apolipoprotein A-I (Apo-A1) is a structural and functional protein that constitutes approximately 70% of the protein in HDL.

Apo-A1 is produced in the liver and intestines and activates lecithin-cholesterol acyltransferase (LCAT) in the peripheral tissues, which transforms free cholesterol to cholesterol ester and facilitates its transportation to the liver, were it is degraded.

Indications/Applications

Because it is not clear whether Apo-A1 is an independent predictor of cardiovascular disease, it may be useful for Apo-A1 to be measured in conjunction with Apo-B to assess the Apo-B/Apo-A1 ratio.

A higher ratio means an increased likelihood of cholesterol deposition in arteries, leading to atherosclerosis and a higher risk of cardiovascular disease.

A prospective cohort study by Xiao et al indicated that as a risk factor, the Apo-B/Apo-A1 ratio is more strongly associated with abdominal aortic aneurysm (AAA) then with coronary heart disease (CHD), despite the relationship of both conditions to atherosclerosis. In addition, Apo-A1 was found to have a greater protective effect against AAA than CHD.[7]

A study by Henson et al indicated that in patients with coronary artery disease, low levels of immune complex consisting of Apo-A1 and immunoglobulin G (IgG) are an independent risk factor for adverse cardiovascular events. Thus, according to the investigators, this immune complex may represent a potential biomarker for predicting cardiovascular disease progression.[8]

Apo-A1 is one of many serum markers used in the fibroTest, a noninvasive assessment of the liver that was validated in many liver disease, including hepatitis C, hepatitis B, nonalcoholic fatty liver disease, and alcoholic liver disease.

Considerations

Serum Apo-A1 is not considered a routine test for cardiovascular disease risk assessment.

Overnight fasting might not be necessary to evaluate apo-A1, but most of the laboratories still commend it.

Apo-A1 Milano is a naturally occurring mutant of Apo-A1 associated with a very low HDL level but apparent longevity and much less atherosclerosis than expected for their HDL-C levels.[9]

A defect in the Apo-A1 gene (APOA1) can cause HDL deficiency and systemic nonneuropathic amyloidosis.

Questions & Answers

Overview

What is the reference range of apolipoprotein A-I (Apo-A1)?

Which conditions are associated with low levels of apolipoprotein A-I (Apo-A1)?

Which conditions are associated with high levels of apolipoprotein A-I (Apo-A1)?

How are specimens collected and prepared for apolipoprotein A-I (Apo-A1) testing?

What is apolipoprotein A-I (Apo-A1)?

What are the indications for apolipoprotein A-I (Apo-A1) measurement?

What are considerations for apolipoprotein A-I (Apo-A1) testing?

Pagana KD, Pagana TJ, Pagana TN. Mosby's Diagnostic and Laboratory Test Reference. 14th ed. St Louis, Mo: Elsevier; 2019.
Teixeira PC, Ducret A, Ferber P, Gaertner H, Hartley O, Pagano S, et al. Definition of human apolipoprotein A-I epitopes recognized by autoantibodies present in patients with cardiovascular diseases. J Biol Chem. 2014 Aug 28. [QxMD MEDLINE Link].
Cochran BJ, Bisoendial RJ, Hou L, Glaros E, Rossy J, Thomas SR, et al. Apolipoprotein A-I Increases Insulin Secretion and Production From Pancreatic ß-Cells via a G-Protein-cAMP-PKA-FoxO1-Dependent Mechanism. Arterioscler Thromb Vasc Biol. 2014 Aug 21. [QxMD MEDLINE Link].
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Henson D, Tahhan AS, Nardo D, Quyyumi AA, Venditto VJ. Association Between ApoA-I (Apolipoprotein A-I) Immune Complexes and Adverse Cardiovascular Events. Arterioscler Thromb Vasc Biol. 2019 Jul 18. ATVBAHA119312964. [QxMD MEDLINE Link]. [Full Text].
Nissen SE, Tsunoda T, Tuzcu EM, Schoenhagen P, Cooper CJ, Yasin M. Effect of recombinant ApoA-I Milano on coronary atherosclerosis in patients with acute coronary syndromes: a randomized controlled trial. JAMA. 2003 Nov 5. 290(17):2292-300. [QxMD MEDLINE Link].
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