Association between the atherogenic index of plasma trajectory and risk of cardiovascular diseases among hypertensive patients: a prospective cohort study

Cardiovascular disease (CVD) remains the leading cause of global mortality, with hypertension and dyslipidemia synergistically exacerbating the atherogenic risk. The atherogenic index of plasma (AIP), calculated as log (triglycerides/HDL-C), reflects lipid-driven atherosclerosis; however, evidence of long-term AIP trajectory patterns and their cardiovascular implications in hypertensive populations remains scarce.

This longitudinal study included 20,013 hypertensive participants (mean age: 56.8 ± 11.0 years; 81.9% male) from the Kailuan cohort, China. The AIP trajectories (2006–2010) were modeled using latent mixture modeling. Cox proportional hazards models were used to assess associations between AIP trajectories and incident CVD (2010–2020), adjusting for demographics, comorbidities, and medications.

Four distinct AIP trajectories were identified: Low-stable group (n = 2,920; AIP range: -0.84 to -0.72), Moderate low-stable group (n = 11,121; AIP range: -0.14 to -0.10), Moderate high-stable group (n = 5,067; AIP range: 0.42 to 0.53), Elevated-increasing group (n = 905; AIP range: 1.12 to 1.46). Over a median of 11.9 (interquartile range 11.3–12.3) years of follow-up, 2,332 CVD events occurred. Compared with the low-stable group, participants in the elevated-increasing trajectory exhibited a 43% higher CVD risk (HR = 1.43, 95% CI:1.14–1.79; P-trend = 0.001), with significantly elevated risks of myocardial infarction (HR = 1.80, 1.09–2.51; P-trend < 0.001) and ischemic stroke (HR = 1.40, 1.08–1.80; P-trend = 0.001). Young hypertensives (< 45 years) with rising AIP trajectories demonstrated a 3.4-fold higher CVD risk (HR = 3.40, 1.03–11.16), whereas no associations were observed for hemorrhagic stroke (P-trend = 0.734).

Sustained elevation in AIP trajectories is associated with a higher risk of CVD in individuals with hypertension. Sustained maintenance of optimal AIP levels through regular monitoring, combined with blood pressure control and antihypertensive medication adherence, may reduce the CVD risk in hypertensive populations.