Homocysteine Combined with Apolipoprotein B as Serum Biomarkers for Predicting Carotid Atherosclerosis in the Oldest-Old

Zhaoyu Liu,1,&ast; Yan Li,2,&ast; Fei Cheng,1 Yue Zhou,1 Miao Chen,1 Chaoxue Ning,3 Bingqi Zhang,4 Yali Zhao3 1Clinical Laboratory, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, People’s Republic of China; 2Transfusion Medicine Department, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, People’s Republic of China; 3Central Laboratory, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, People’s Republic of China; 4Ultrasound Diagnosis Department, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yali Zhao, Central Laboratory, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, 572000, People’s Republic of China, Email zhaoyl301hn@163.comBackground: The measurement of serum biomarkers is a promising decision aid in the assessment of atherosclerosis. However, data on the levels and epidemiological distribution of serum biomarkers of carotid atherosclerosis (CAS) in the oldest-old are limited. This study aimed to investigate the characteristics of CAS serum biomarkers in the oldest-old over 80 and explore their predictive value for CAS.Methods: As part of the China Hainan Centenarian Cohort Study, a total of 1565 individuals over 80 years old were included. Atherosclerosis was assessed by carotid plaque and carotid intima-media thickness. Serum biomarker levels, demographic indicators, and physical examination indicators were detected. Prediction factors correlated to the CAS were explored by logistic regression and verified by receiver operating characteristic curve analysis. Multivariate regression models were fitted, along with subgroup analysis and robustness tests.Results: Among the oldest-old population, 83.5% (1306) had CAS. In a fully adjusted multivariate logistic regression model, systolic blood pressure (SBP), heart rhythm (HR), serum homocysteine (Hcy), and apolipoprotein B (ApoB) levels were significantly and positively associated with CAS in the oldest-old (PS < 0.001). ROC analysis indicated that the combination of serum Hcy, ApoB, SBP, and HR increased the predictive value for CAS in the oldest-old (area under the curve: 0.856, 95% CI: 0.803– 0.879; sensitivity: 81.8%; specificity: 85.9%).Conclusion: SBP, HR, Hcy and ApoB are independent risk factors for CAS in the oldest-old. The specific set of biomarkers and their combination with other risk markers may be a promising strategy for assessing CAS in the elderly, especially in global aging.Keywords: carotid atherosclerosis, carotid intima-media thickness, biomarker, homocysteine, apolipoprotein B