Invest Clin 63(4): 388 - 399, 2022 https://doi.org/10.54817/IC.v63n4a06
Corresponding author: Yanbin Song. No. 2, Yongning North Road, Changzhou, Jiangsu, China. Telephone: 86+
0519-85579192. E-mail: songyb1984@126.com
Blood group B and decreased risk of coronary
artery disease in hypertensive elderly.
Yanbin Song and Wenhua Li
Department of Cardiology, Wujin Hospital affiliated to the Jiangsu University,
Changzhou, China; the Wujin Clinical College of Xuzhou Medical University,
Changzhou, China.
Keywords: ABO blood groups; cardiovascular disease; elderly; hypertensive; Gensini
score.
Abstract. Although ABO blood groups have been associated with cardio-
vascular disease, little is known about whether ABO blood groups contribute
to the risk of the presence and severity of coronary artery disease (CAD) in
elderly individuals with hypertension. This study was aimed to explore this as-
sociation. A total of 793 hypertensive patients aged ≥60 years out of 2095
patients who underwent primary coronary angiography were retrospectively
included. They were divided into CAD and non-CAD groups. Demographic and
clinical characteristics, ABO blood groups and other biochemical parameters
were compared. Further evaluation was performed to determine the impact of
ABO blood groups on CAD severity using the Gensini score and the number of
significantly diseased vessels. A logistic regression model was constructed to
identify the association of ABO blood groups with CAD. There was a substantial
difference in the distribution of ABO blood groups in elderly and hypertensive
adults with and without CAD (p=0.022). Hypertensive patients with CAD had
a significantly lower proportion of the blood group B than those without CAD
(p=0.008). Compared to those with non-Blood group B, hypertensive elderly
with a blood group B tended to have significantly lower concentrations of TC,
LDL-C and Apo B, and a lower number of significantly stenosed vessels. The
blood group B was found to be an independent protective factor for CAD in
elderly with hypertension. The blood group B is significantly associated with a
decreased risk of CAD and is inversely correlated with the severity of coronary
stenosis in the elderly with hypertension.
Blood group B and decreased risk of coronary artery disease in hypertensive elderly 389
Vol. 63(4): 388 - 399, 2022
Grupo sanguíneo B y disminución del riesgo de enfermedad
arterial coronaria en ancianos hipertensos.
Invest Clin 2022; 63 (4): 388 – 399
Palabras clave: tipo de sangre ABO; enfermedades cardiovasculares; anciano; presión
arterial alta; puntuación de Gensini.
Resumen. Aunque los tipos de sangre ABO están asociados con enferme-
dades cardiovasculares, se sabe poco sobre si los tipos de sangre ABO estás
relacionados con la presencia y gravedad de la enfermedad arterial coronaria
(CAD) en pacientes de edad avanzada con hipertensión. El objetivo de este
estudio fue explorar esta relación. Se incluyeron retrospectivamente un total
de 793 pacientes hipertensos de ≥60 años tomados de un grupo de 2095 pa-
cientes sometidos a angiografía coronaria primaria. Se dividieron en el grupo
de cardiopatía coronaria (CAD) y el grupo sin cardiopatía coronaria (no-CAD).
Se compararon las características demográficas y clínicas, el grupo sanguíneo
ABO y otros parámetros bioquímicos. El efecto del grupo sanguíneo ABO so-
bre la gravedad de la CAD se evaluó con la puntuación Gensini y el número de
vasos sanguíneos patológicos significativos. Se construyó un modelo de regre-
sión logística para determinar la relación entre el grupo sanguíneo ABO y la
CAD. Hubo una diferencia significativa en la distribución de los grupos sanguí-
neos ABO entre los ancianos con y sin cardiopatía coronaria y los adultos con
hipertensión (P=0,022). La proporción del grupo sanguíneo B en pacientes
hipertensos con cardiopatía coronaria fue significativamente menor que en pa-
cientes sin cardiopatía coronaria (P=0,008). En comparación con los grupos
sanguíneos no B, las concentraciones de TC, LDL - C y Apolipoproteína B en
los ancianos hipertensos del Grupo B fueron significativamente menores, y el
número de estenosis vascular fue significativamente menor. El Grupo B es un
factor protector independiente de la CAD en pacientes de edad avanzada con
hipertensión. El Grupo B se correlacionó significativamente con la reducción
del riesgo de cardiopatía coronaria y negativamente con la gravedad de la este-
nosis coronaria en pacientes de edad avanzada con hipertensión.
Received: 24-06-2022 Accepted: 19-09-2022
INTRODUCTION
Coronary artery disease (CAD) is a well-
documented major threat to human health
worldwide and it accounts for approximately
17.8 million deaths annually. It is the lead-
ing cause of mortality and disability, and it
is preventable 1-4. There is robust evidence
that environmental and genetic factors con-
tribute to the risk of CAD 5-6. Hypertension
is a significant risk factor for CAD in most
populations.
The ABO blood group, as a genetic
risk factor, has been demonstrated to be re-
lated to cardiovascular disease and cardiac
deaths in the overall population. Although
the relationship is still controversial, mul-
tiple studies have reported that people with
390 Song and Li
Investigación Clínica 63(4): 2022
blood Group A are more vulnerable to coro-
nary stenosis than those with non-A blood
groups. And individuals with blood Group O
have been linked to a lower risk of CAD 7-8.
However, a study performed on Bangladeshi
people revealed that the blood group O was
associated with a substantially increased risk
of CAD 9. In addition, the blood group AB
has been reported to play an important role
in a decreased risk of CAD 10. Thus, the asso-
ciation of ABO blood groups with the devel-
opment of CAD is inconsistent in different
races and populations.
On the other hand, a possible protective
effect of the Blood group B against several
diseases, including cardiovascular events,
has been observed. In addition, it has been
reported that patients with the blood group
B are less likely to develop pancreatic neu-
roendocrine tumors and other pancreatic
masses in the Chinese population 11. Mean-
while, a nationwide cohort study suggested
that blood group B conferred a lower risk of
aortic aneurysms than the blood group O12. A
meta-analysis including 241.868 Hepatitis B
virus (HBV)-infected subjects and 6.487.481
uninfected subjects also found that blood
group B was associated with a lower risk of
HBV infection (RR=0.92, 95% CI 0.86 to
0.98) 13. Thus, whether ABO blood groups
are related to CAD and other diseases and
which antigen is a protective or a risk factor
remains controversial.
Individuals with blood group B account
for approximately 25% of the Chinese popu-
lation. It is necessary to pay more attention
to the relationship between CAD and blood
group B due to its large proportion of the
community. To the best of our knowledge,
whether blood group B contributes to CAD
risk and the severity of CAD has not been
definitely established.
Moreover, age itself is a well-established
risk factor for the development of cardiovas-
cular disease, and older adults are associated
with increased CAD because of age-mediated
damage 14. Several conventional risk factors
for incident CAD, including smoking, male
sex, hyperlipidemia and a prior history of hy-
pertension, are different between older and
young patients 15-17. A study conducted on
Chinese Taiwanese young adults indicated
that blood group A was an independent risk
factor for CAD and myocardial infarction
compared to non-A blood groups 18. Howev-
er, evidence is not fully available regarding
the relationship between the distribution of
ABO blood groups and CAD risk and severity
as assessed by the Gensini score and the sig-
nificantly diseased vessels in subjects aged
60 years or older, especially in those with hy-
pertension. Hypertension is one of the most
common chronic diseases in Chinese adults.
A total of 23.2% of the adult population has
hypertension.
Therefore, we performed this study
to elucidate the relationship between ABO
blood groups and CAD by retrospective anal-
ysis of the data from elderly adults with hy-
pertension undergoing primary diagnostic
coronary angiography (CAG) at our center.
PATIENTS AND METHODS
Study participants
A total of 793 elderly patients with hy-
pertension (mean age of 69.13± 5.81 years,
62.6% were men) from among 2095 subjects
hospitalized due to angina, coronary myo-
cardial infarction or heart failure symptoms
were consecutively included. All the study
patients underwent primary CAG at the De-
partment of Cardiology, Wujin Hospital, af-
filiated with the Jiangsu University, between
2014 and 2018.
Ineligible patients were excluded if they
(1) had severe hepatic or renal dysfunction
(n=2) or hyperthyroidism or hypothyroidism
(n=29); (2) underwent lipid-lowering thera-
py during the three months prior to our study
(n=136); (3) lacked information about their
ABO blood groups or lipid profiles (n=381);
(4) were younger than 60 years (n=480); or
(5) did not have hypertension.
Two experienced cardiologists evalu-
ated the CAG results. CAD was defined as
Blood group B and decreased risk of coronary artery disease in hypertensive elderly 391
Vol. 63(4): 388 - 399, 2022
stenosis of 50% or more of the diameter of
the major coronary vessels. Patients were di-
vided into CAD and non-CAD groups based
on the CAG results.
Written informed consent was not ob-
tained from the included patients because
the relevant data were retrospectively ob-
tained from their electronic medical re-
cords. Nevertheless, our study complied with
the Declaration of Helsinki (2013) and was
approved by the Ethics Committee of Wujin
Hospital, affiliated with Jiangsu University,
Changzhou, China.
Baseline parameter analysis
The investigators collected baseline
characteristics regarding sex, age, smoking,
drinking, and diabetes mellitus (DM) from
the electronic medical records. Venous blood
samples were collected from study cases in a
fasting state on the morning following the
admission day. The ABO blood groups of all
of the patients were determined. Plasma
lipid levels, including total cholesterol (TC),
triglyceride (TG), low-density lipoprotein
cholesterol (LDL-C), high-density lipopro-
tein cholesterol (HDL-C), apolipoprotein
A-1 (ApoA-1) and apolipoprotein B (Apo B),
were obtained using standard techniques.
The atherogenic index of plasma (AIP) was
calculated as Log (TG/HDL-C). The number
of diseased coronary vessels with ≥ 50% ste-
nosis was calculated for the patients accord-
ing to the results of coronary angiography.
Gensini score assessment
The severity of coronary artery stenosis
was also evaluated by the Gensini score (GS)
based on the results of CAG for the included
cases. Reductions in coronary lumen diam-
eter of 25%, 50%, 75%, 90%, and 99%, and
complete occlusion were counted as 1, 2,
4, 8, 16, and 32, respectively. A multiplier
was then assigned to each main vascular seg-
ment based on the functional significance:
5 for the left main coronary artery, 2.5 for
the proximal segment of the left anterior de-
scending (LAD) coronary artery, 2.5 for the
proximal segment of the left circumflex ar-
tery (LCX), 1.5 for the mid-segment of the
LAD, 1.0 for the distal segment of the LAD,
mid-distal region of the LCX, the obtuse mar-
ginal artery, the right coronary artery and
the posterolateral artery, and 0.5 for other
segments. The final score was calculated by
adding the scores of each segment19.
Definitions
Hypertension was defined as systolic
blood pressure (SBP) of ≥ 140 mmHg and/
or diastolic blood pressure (DBP) of ≥ 90
mmHg or the use of any antihypertensive
drug. DM was defined as a fasting plasma
glucose ≥ 7.0 mmol/L, a nonfasting plasma
glucose ≥ 11.1 mmol/L, or the current use
of antidiabetic medications, including insu-
lin or oral hypoglycemic agents. Smoking
was defined as cigarette intake (current or
stopped < 1 year ago). Drinking was defined
as current alcohol intake (once per month
to ≤ 4 times per week [moderate], or daily/
almost daily [high]).
Statistical analysis
Continuous data with a normal distri-
bution are presented as the mean ± stan-
dard deviation (SD). The significance was
evaluated by using Student’s t-test or ANO-
VA. The remaining continuous data are
represented as the median [quartile range
(QR)] and compared using the Mann–Whit-
ney U test among groups. Categorical data
are reported as frequencies and percentages.
The chi-square test was used to evaluate the
significance. Multivariate logistic regression
analysis was applied to detect the effect of
the ABO blood group on CAD. The regres-
sion model was established using the for-
ward Wald method. The inclusion level was
set as 0.5, and the exclusion level was 0.1.
Odds ratios (ORs) and 95% confidence inter-
vals (95% CIs) were computed. All statistical
analyses were conducted using SPSS 25.0
statistics software. A P value of < 0.05 was
considered to be statistically significant.
392 Song and Li
Investigación Clínica 63(4): 2022
RESULTS
The baseline characteristics of the study
participants
As shown in Table 1, the elderly and
hypertensive patients were assigned to the
CAD group (n=556, aged 69.67±5.89 years,
62.6% men) and non-CAD group (n=237,
aged 67.88±5.42 years, 44.3% men). Male
sex was more prevalent in the CAD group.
There were more smokers in the CAD group
than in the non-CAD group (p < 0.001). CAD
patients were older, had a higher prevalence
of DM, and had significantly higher LDL-C,
Apo B and AIP values than non-CAD (all p <
0.05). Compared with the non-CAD group,
the CAD group had significantly lower HDL-
C and Apo A-1 (all p < 0.01). There were no
differences in TC and TG levels between the
two groups.
The overall distribution of ABO blood
groups was different between those with
and without CAD (A 36.0% vs. 29.5%, AB
12.1% vs. 8.0%, B 24.6% vs. 33.8%, O 27.3%
vs. 28.7%, p=0.022). A statistically lower
frequency of blood group B was observed in
the CAD group than in the non-CAD group
(33.8% vs. 24.6%, p=0.008).
Lipid profiles between blood group B
and group non-B in elderly individuals
with hypertension
Comparison of lipid profiles between
blood group B and non-B groups are pre-
sented in Table 2. The data revealed that
hypertensive elderly individuals in the blood
group B had significantly lower TC, LDL-C,
and Apo B concentrations than those in the
non-blood group B (p= 0.008, 0.010 and
0.007, respectively). However, there were no
Table 1
Baseline characterstics of study participants with and without coronary artery disease.
Variables Hypertensive elderly with CAD
(n=556)
Hypertensive elderly without CAD
(n=237)
P
Male, n (%) 348 (62.6) 105(44.3) < 0.001
Smoking, n (%) 196 (35.3) 44(18.6) < 0.001
Drinking, n (%) 67(12.1) 22(9.3) 0.258
Age, y 69.67±5.89 67.88±5.42 < 0.001
DM, n (%) 185 (33.3) 53(22.4) 0.002
TC, mmol/L 4.61±1.05 4.46±0.99 0.053
TG, mmol/L 1.49(1.08-2.04) 1.40(1.03-2.06) 0.280
HDL-C, mmol/L 1.10±0.26 1.17±0.31 0.001
LDL-C, mmol/L 2.91±0.90 2.61±0.78 < 0.001
Apo A-1, g/L 1.21±0.23 1.27±0.24 0.001
Apo B, g/L 0.95±0.26 0.89±0.24 0.005
AIP 0.15±0.28 0.11±0.29 0.047
ABO, n (%) 0.022
A 200 (36.0) 70 (29.5) 0.080
AB 67(12.1) 19(8.0) 0.094
B 137 (24.6) 80(33.8) 0.008
O 152 (27.3) 68 (28.7) 0.697
CAD: coronary artery disease; DM: diabetes mellitus; TC: total cholesterol; TG: triglyceride; HDL-C: high-density
lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; Apo A-1: apolipoprotein A-1; Apo B: apolipopro-
tein B; AIP: atherogenic index of plasma.
Blood group B and decreased risk of coronary artery disease in hypertensive elderly 393
Vol. 63(4): 388 - 399, 2022
significant differences in the HDL-C, Apo A1
and AIP levels between the two groups (p =
0.778, 0.123 and 0.377, respectively).
Severity of coronary artery stenosis and
blood group B in hypertensive elderly
individuals
Table 3 shows that hypertensive elderly
patients in the blood group B were likelier
to have a significantly lower number of dis-
eased coronary vessels than those in the non
B -blood group (p=0.031). In addition, af-
ter the Gensini score was assigned to the 1st
tertile (0-11.5), 2nd tertile (11.5-35.5) and
3rd tertile (>35.5), the data revealed that
blood group B tended to be associated with a
significantly lower Gensini score tertile than
the non- Bs blood groups. However, there
was not a significant difference (p= 0.215).
Logistic regression analysis of the blood
group B and CAD in elderly individuals
with hypertension
Binary multivariate logistic regression
was conducted to establish whether the
blood group B was an independent factor
for CAD risk in the patients. According to
the univariate regression results shown in
Table 4, variables including age (OR 1.057,
95% CI 1.028-1.087), male sex (OR 2.103,
95% CI 1.545-2.863), smoking (OR 2.388,
95% CI 1.648-3.460), DM (OR 1.731, 95%
CI 1.217-2.464), HDL-C (OR 0.375, 95%
CI 0.219-0.642), LDL-C (OR 1.524, 95%
CI 1.262-1.840), Apo A1 (OR 0.338, 95%
CI 0.177-0.645), Apo B (OR 2.420, 95% CI
1.299-4.510) and blood group B (OR 0.642,
95% CI 0.461-0.894) were included in the
model.
After adjustment for such cardiovascu-
lar risk factors, multiple logistic regression
analysis indicated that the blood group B
remained an independent protective factor
for CAD (OR 0.642, 95% CI 0.450-0.916)
in elderly patients. Moreover, age, male sex,
smoking, DM, LDL-C and AIP were signifi-
cantly related to an increased risk of CAD
(OR= 1.068, 95% CI 1.037-1.100; OR=
1.972, 95% CI 1.329-2.928; OR= 1.966, 95%
CI 1.244-3.108; OR= 2.085, 95% CI 1.420-
3.060, OR= 1.706, 95% CI 1.388-12.096,
and OR=1.737, CI 1.006~2.998, respective-
ly). HDL-C was an independent protective
factor for CAD (OR= 0.422, 95% CI 0.236-
0.753), Table 5.
DISCUSSION
In this study, we explored the associa-
tion of ABO blood groups with the incidence
of CAD and CAD severity in elderly individu-
als with hypertension. We obtained two cru-
Table 2
Lipid profiles between blood group B and group non-B.
Lipids blood group B
(n=217)
blood group non-B
(n=576)
P
TC, mmol/L 4.41±0.97 4.63±1.06 0.008
TG, mmol/L 1.4(1.01-2.04) 1.49(1.09-2.07) 0.237
HDL-C, mmol/L 1.11±0.28 1.12±0.28 0.778
LDL-C, mmol/L 2.70±0.73 2.86±0.92 0.010
Apo A-1, g/L 1.21±0.25 1.24±0.23 0.123
Apo B, g/L 0.89±0.25 0.94±0.26 0.007
AIP 0.13±0.28 0.15±0.28 0.377
TC: total cholesterol; TG: triglyceride; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein
cholesterol; Apo A-1: apolipoprotein A-1; Apo B: apolipoprotein B; AIP: atherogenic index of plasma.
394 Song and Li
Investigación Clínica 63(4): 2022
cial results about the association between
blood group B and newly angiography-diag-
nosed CAD in hypertensive elderly individu-
als. First, after adjusting for confounding
factors, an association of blood group B with
a decreased risk of CAD was observed in el-
derly individuals with hypertension. Second,
a statistically lower number of significantly
diseased coronary vessels was detected in
hypertensive elderly individuals with blood
group B than those without this group.
ABO blood group antigens are ex-
pressed not only on the surface of red blood
cells but also on various human tissues, such
as the epithelium, platelets, and vascular
endothelium 20. Thus, the ABO blood group
is considered a risk factor for cardiovascu-
lar and thrombotic diseases 21-24. It has been
Table 3
Coronary stenosis severity between blood group B and blood group non-B.
Variable blood group B
(n=217)
blood group non-B
(n=576) P
Number of diseased vessels 0.031
0 80(36.9) 158(27.4)
1 64(29.5) 184(31.9)
≥2 73(33.6) 234(40.6)
Gensini score 0.215
1st tertile (0-11.5), n (%) 82(37.8) 181(31.4)
2ed tertile (11.5-35.5), n (%) 65(30.0) 199(34.5)
3rd tertile (>35.5), n (%) 70(32.3) 196(34.0)
Table 4
Univariate regression analysis for risk factors and coronary artery disease.
Variable B S.E Wald Sig. Exp (B) 95% CI
Male 0.744 0.157 22.308 0.000 2.103 1.545~2.863
Age 0.055 0.014 15.413 0.000 1.057 1.028~1.087
Smoking 0.871 0.189 21.174 0.000 2.388 1.648~3.460
Drinking 0.292 0.259 1.271 0.260 1.339 0.806~2.225
DM 0.549 0.180 9.295 0.002 1.731 1.217~2.464
TC 0.147 0.076 3.726 0.054 1.159 0.998~1.346
TG 0.061 0.071 0.737 0.391 1.063 0.924~1.223
HDL-C -0.981 0.275 12.734 0.000 0.375 0.219~0.642
LDL-C 0.421 0.096 19.108 0.000 1.524 1.262~1.840
Apo A1 -1.086 0.330 10.812 0.001 0.338 0.177~0.645
Apo B 0.884 0.318 7.750 0.005 2.420 1.299~4.510
AIP 0.552 0.279 3.927 0.048 1.737 1.006~2.998
Blood group B -0.444 0.169 6.893 0.009 0.642 0.461~0.894
CAD: coronary artery disease; DM: diabetes mellitus; TC: total cholesterol; TG: triglyceride; HDL-C: high-density
lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; Apo A-1: apolipoprotein A-1; Apo B: apolipopro-
tein B; AIP: atherogenic index of plasma.
Blood group B and decreased risk of coronary artery disease in hypertensive elderly 395
Vol. 63(4): 388 - 399, 2022
shown in previous studies that individuals
with blood group A have a higher risk of CAD
compared with non-A blood groups. Further-
more, a second CAG indicates that in-stent
restenosis is significantly more prevalent in
individuals with blood group A compared to
other blood groups 25. However, several stud-
ies revealed that ABO blood groups are not
associated with CAD in the general popula-
tion26-27. Whether blood group B is associated
with CAD in the Chinese population remains
controversial. Few reports have focused on
the association of blood group B with CAD
risk and severity, especially in elderly and hy-
pertensive subjects who suffer from a cardio-
vascular disease burden.
In the present study, we investigated
the association between ABO blood types
and CAD defined by primary CAG in the
Chinese elderly population with hyperten-
sion. Our results do not reveal a significantly
higher frequency of blood group A in elderly
and hypertensive patients with CAD than
in the rest of the population. This finding
is inconsistent with the results of a previ-
ous study, which found that blood group A
is an independent risk factor for CAD and
MI in a young Chinese population 18. To our
knowledge, the available evidence suggests
that blood group O is related to a decreased
risk of CAD in general subjects. Further-
more, research conducted in India showed
that the blood group B reduced the risk of
CAD due to an associated higher concentra-
tion of HDL-C in the general population 10.
However, our study did not observe these re-
lationships among elderly adults.
Our data revealed that hypertensive el-
derly individuals with blood group B had a
significantly lower risk of CAD than those
with non-B blood groups. Further analysis
suggested that blood group B was an inde-
pendent protective factor against incident
CAD. These results are inconsistent with ob-
servations of the blood group B as a predic-
tor of CAD among general subjects 28. The
possible mechanism underlying these varia-
tions is the enrollment of patients from dif-
ferent races or populations. Furthermore, a
recent study suggested that although there
were no differences between blood group O
or B compared with A or AB for serum in-
flammatory cytokines, patients with blood
group O or B had a reduced disease severity
and multiorgan dysfunction in COVID-19 29.
Moreover, it has been reported that patients
with blood group O have decreased levels of
factor VII and von Willebrand factor, which
may account for the underlying protective
effect against cardiovascular disease 22,30.
Central to these findings, additional studies
are required to define the biological mecha-
nisms of our results, which have not been
elucidated due to a lack of essential data.
Table 5
Multiple logistic regression analysis for risk factors for coronary artery disease.
Variable B S.E Wald Sig. Exp (B) 95% CI
Age 0.065 0.015 18.893 0.000 1.068 1.037~1.100
Male 0.679 0.202 11.352 0.001 1.972 1.329~2.928
Smoking 0.676 0.234 8.379 0.004 1.966 1.244~3.108
DM 0.735 0.196 14.068 0.000 2.085 1.420~3.060
HDL-C -.864 0.296 8.521 0.004 0.422 0.236~0.753
LDL-C 0.534 0.105 25.828 0.000 1.706 1.388~2.096
Blood group B -.443 0.181 5.973 0.015 0.642 0.450~0.916
CAD: coronary artery disease; DM: diabetes mellitus; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-
density lipoprotein cholesterol.
396 Song and Li
Investigación Clínica 63(4): 2022
It has long been recognized that TG and
LDL-C are common risk factors, and HDL-
C and Apo A1 are protective factors against
cardiovascular disease and major adverse
cardiac events after percutaneous coronary
intervention 31-33. AIP is strongly associated
with atherogenesis of the coronary artery.
In the present study, we similarly found that
patients with CAD were more likely to have
higher levels of LDL-C Apo B and AIP and
lower concentrations of HDL-C and Apo
A-1. Schmitz and Kaminski 34 found that the
prototypic ATP binding cassette transporter
ABCA2, which plays a pivotal role in trans-
membrane cholesterol export, and the ABO
gene are both located on chromosome 9q34.
Based on these findings, studies have been
conducted to explore the potential relation-
ship of ABO blood groups with lipid metab-
olism in the incidence and development of
CAD. Higher plasma levels of TC and LDL-C
are involved in the association between the
ABO blood group and incident CAD. Approx-
imately 10% of the effect of non-O type on
CAD and myocardial infarction susceptibil-
ity was mediated by its influence on LDL-C
levels 35-37. Consistent with previous findings,
our data revealed that hypertensive older in-
dividuals with blood group B had significantly
lower LDL-C and Apo B concentrations than
those with non-B blood groups. Likewise, the
results of our study demonstrated that TC,
LDL-C, and Apo B might play an essential
mediating role in the effect of blood group
B on the decreased risk of CAD. Consistent
with previous studies, LDL-C was associated
with an increased risk of CAD, and HDL-C
was a protective factor against CAD.
As a risk factor for CAD, the A blood
group has been shown to be positively associ-
ated with the severity of coronary atheroscle-
rosis as assessed by the Gensini score 7. In-
consistent with this study, a study conducted
on young Chinese showed no consistent as-
sociation of ABO blood groups with CAD se-
verity estimated using significantly diseased
vessels 18. However, our work findings re-
flected that hypertensive elderly individuals
with blood group B were more likely to have
a significantly lower number of diseased ves-
sels. In addition, although a significant dif-
ference was not observed, hypertensive older
individuals with blood group B were prone to
have low Gensini scores, which provided ad-
ditional evidence for the association. These
factors might lead to benefits for seniors
with hypertension and blood group B. This
may help identify high-risk elderly individu-
als early and reduce the risk of cardiovascu-
lar events.
There were several limitations in the
present study. First, this study was retro-
spective, in which several risk factors, in-
cluding BMI and uric acid, were not consid-
ered. Second, it was a single-center study
conducted on a selected group of Chinese
patients. The results might be biased due to
its relatively small sample. Third, there is no
known mechanism to explain the association
of blood group B with CAD. Therefore, larg-
er samples and multicenter and prospective
studies are necessary to confirm our find-
ings in elderly patients with hypertension.
The current study reveals that blood
group B is associated with decreased CAD
risk in Chinese hypertensive subjects aged
60 years or older. In the future, more re-
search is needed to clarify the mechanism
underlying the protective effect of blood
group B against CAD in these individuals.
ACKNOWLEDGMENTS
We are grateful for the contributions of
our colleagues at the Department of Cardiol-
ogy, Wujin Hospital, Affiliated with Jiangsu
University, Changzhou, China.
Funding
This study was supported by the Scien-
ce and Technology Support Project (Social
development) of Changzhou (CE20205004).
Blood group B and decreased risk of coronary artery disease in hypertensive elderly 397
Vol. 63(4): 388 - 399, 2022
Conflict of interest
The authors declare that they have no
competing interests.
Author’s ORCID numbers
• Yanbin Song: 0000-0001-6314-9230
• Wenhua Li: 0000-0001-5496-0435
Author Participation
• Conception or the design of the man-
uscript: YS.
• Analysis and interpretation of the
data: YS.
• Draft and revise the manuscript: YS,
WL.
• Read and approve the final version of
the manuscript: YS, WL.
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