Introduction: Hypertension is associated with increased arterial stiffness, which is a predictor of cardiovascular risk and has been shown to correlate with lipid profile. However, the effect of alternative measures of lipid profile other than LDL remains unknown.

Methods: We enrolled 1225 consecutive essential hypertensives (mean age 52.9±11.7 years, 728 males). Arterial stiffness was determined with carotid-femoral pulse wave velocity (PWV) using the Complior® device. Total cholesterol, LDL cholesterol, non-HDL cholesterol, and apolipoprotein B, as well as ratios of total/HDL cholesterol, LDL/HDL cholesterol, and apolipoprotein B/A-I were measured or calculated, accordingly.

Results: In multivariable regression analysis, apolipoprotein B/A-I ratio, LDL and total/HDL cholesterol ratio exhibited significant positive association with PWV, which was independent of age, gender, mean blood pressure, smoking, BMI, diabetes, triglycerides, CRP and all the aforementioned measures of lipid profile (p<0.001, p<0.001 and p<0.05, adjusted R2 of model=0.402). In further analyses we employed dichotomous outcome variable (PWV ≥75th percentile [9.1 m/s]). Receiver operating characteristic (ROC) curves were generated to evaluate the ability of apolipoprotein B/A-I ratio, LDL and total/HDL cholesterol ratio to discriminate subjects with and without significant arterial stiffness. The area under the curve (AUC) and 95% CIs of the ROC curves for apolipoprotein B/A-I ratio, LDL and total/HDL cholesterol ratio for prediction of significant arterial stiffness (PWV ≥75th percentile [9.1 m/s]) were AUC=0.64 (p<0.001), AUC=0.53 (P=0.07) and AUC=0.58 (p<0.001).

Conclusion: Higher apolipoprotein B/A-I and total /HDL cholesterol ratios are independent predictors of increased arterial stiffness in never-treated hypertensives and predict increased arterial stiffness better than LDL.