AIP (Atherogenic Index of Plasma)

The Atherogenic Index of Plasma (AIP) is a calculated number based on two routine lipid results: triglycerides (TG) and HDL cholesterol (HDL-C). It is calculated as AIP = log₁₀ (TG/HDL-C). In simple terms, AIP compresses the triglyceride-to-HDL balance into one value so it’s easier to compare across people and over time. This matters because triglycerides and HDL don’t just “sit” in the blood — they reflect how your body is packaging, transporting, and clearing fats (lipids) for energy and hormone production. When triglycerides are higher and HDL is lower, your body tends to carry more small, dense LDL particles (sdLDL). These are a subtype of LDL that are more likely to enter artery walls and contribute to plaque formation. AIP is therefore used as a surrogate marker (an indirect marker) of a more atherogenic particle pattern.

Because AIP is derived from standard lipids, it’s accessible and practical, and it can be helpful in metabolic states where triglycerides rise and HDL drops (such as insulin resistance). AIP values often fall roughly between -0.3 and 0.7, with higher values generally indicating higher cardiovascular risk; many studies use cut points around 0.11 to 0.24 to define “higher risk,” while values below ~0.11 are often considered more optimal, depending on the population studied.

AIP matters because it captures cardiovascular risk that isn’t always obvious from LDL cholesterol alone. Traditional panels often focus on LDL (“bad cholesterol”), but LDL cholesterol is the amount of cholesterol carried inside LDL particles — not the type of particles nor how triglyceride-rich particles and HDL function together. AIP integrates two lipid features that strongly track with cardiometabolic health: triglyceride burden (often reflecting higher VLDL and remnant particles) and HDL protection (reflecting reverse cholesterol transport capacity). When AIP is high, it usually indicates the combination most strongly associated with an atherogenic lipid pattern: high TG + low HDL. This pattern is closely linked to small, dense LDL, impaired lipid clearance, and a metabolic environment that supports inflammation and plaque progression.

Large observational studies and meta-analyses show that higher AIP is associated with a greater likelihood of coronary artery disease, greater severity of coronary disease (including multi-vessel disease), and faster progression of atherosclerosis over time. AIP has also been shown to predict future major cardiovascular outcomes (heart attack, stroke, cardiovascular death) across multiple populations. Importantly, AIP is also strongly tied to metabolic syndrome, and it tends to be higher in people with type 2 diabetes, obesity (especially abdominal/visceral fat), hypertension, and obstructive sleep apnoea, reflecting shared underlying drivers like insulin resistance and altered lipid metabolism. In this way, AIP often acts like a “metabolic warning light” that your body is producing and circulating more triglyceride-rich particles while HDL is not keeping pace.

Because AIP moves with triglycerides and HDL, it can also be useful to monitor response to lifestyle change (especially carbohydrate quality/quantity, activity levels, and weight change). It is not a diagnosis, but it can be a strong signal that your cardiovascular risk is higher than you might expect from standard cholesterol numbers alone—particularly if you are in a cardiometabolic risk phenotype.

Dietary factors

Because AIP is driven by triglycerides and HDL, the most powerful dietary drivers are those that raise triglycerides and/or lower HDL. Refined carbohydrates and added sugars (soft drinks, fruit juice, sweetened coffees, pastries, lollies, white bread/rice/pasta) can raise triglycerides by increasing liver triglyceride production, especially in people with insulin resistance. This tends to push AIP up. Diet patterns that reduce refined carbs and prioritize high-fibre whole foods often improve triglycerides and support healthier HDL, lowering AIP. Fat quality matters too: replacing saturated fats from highly processed animal foods with unsaturated fats (olive oil, avocado, nuts, seeds, fatty fish) tends to support a more favourable lipid balance and can reduce AIP through triglyceride effects and HDL support.

Lifestyle factors

Regular physical activity tends to improve AIP by lowering triglycerides and supporting HDL. Consistent activity spread through the week appears more favourable than highly concentrated “weekend-only” patterns. Higher sedentary time and lower fitness are associated with worse AIP values. Body weight — especially visceral/abdominal fat — is one of the strongest determinants: weight gain tends to raise AIP, and even modest weight reduction (around 5–10% of body weight) can materially improve triglycerides, often improving AIP as a downstream effect.

Related biomarkers and conditions

AIP rises most directly when triglycerides rise and/or HDL falls. It commonly clusters with insulin resistance markers and metabolic syndrome features, and it often tracks with blood glucose/HbA1c, blood pressure, and inflammatory markers like hs-CRP. These relationships reflect a shared metabolic terrain rather than one isolated lipid issue.

Micronutrients and nutrient status

AIP is not a micronutrient marker, but nutrients that improve triglycerides and HDL can indirectly shift AIP. Omega-3 intake (dietary or supplemental) is a classic example because it can reduce triglycerides; certain micronutrients and antioxidants may support lipid profiles in some contexts, though AIP-specific evidence varies across studies.

Lowering AIP reflects improved metabolic efficiency and cardiovascular resilience. These evidence-based habits help shift your ratio in the right direction:

• Prioritise movement. Include daily aerobic exercise and two to three sessions of strength training each week. Even “weekend warrior” activity lowers AIP in studies.

• Reduce simple carbohydrates and added sugars. Replace refined starches and sweets with fibre-rich whole foods.

• Embrace healthy fats. Choose olive oil, avocado, nuts, and oily fish. Limit trans fats and deep-fried foods.

• Improve meal timing and fasting windows. Reducing late-night eating and extending overnight fasting can improve triglyceride and HDL metabolism.

• Lose visceral fat gradually. Even a 5–10% reduction in body fat can significantly improve AIP.

• Sleep and recover well. Aim for 7–9 hours of quality sleep; treat snoring or sleep apnea if present.

• Support thyroid and liver health. Ensure adequate iodine and selenium intake, stay hydrated, and limit alcohol.

1. Kim JJ, Yoon J, Lee YJ, Park B, Jung DH. Predictive value of the atherogenic index of plasma (AIP) for the risk of incident ischemic heart disease among non-diabetic Koreans. Nutrients. 2021;13(9):3231. doi:10.3390/nu13093231.

2. Assempoor R, Daneshvar MS, Taghvaei A, et al. Atherogenic index of plasma and coronary artery disease: A systematic review and meta-analysis of observational studies. Cardiovascular Diabetology. 2025;24(1):35. doi:10.1186/s12933-025-02582-2.

3. Wang L, Chen F, Xiaoqi C, Yujun C, Zijie L. Atherogenic index of plasma is an independent risk factor for coronary artery disease and a higher SYNTAX score. Angiology. 2021;72(2):181-186. doi:10.1177/0003319720949804.

4. Zhao M, Xiao M, Zhang H, et al. Relationship between plasma atherogenic index and incidence of cardiovascular diseases in Chinese middle-aged and elderly people. Scientific Reports. 2025;15(1):8775. doi:10.1038/s41598-025-86213-6.

5. Rashidian P, Mirchandani M, Somu KP, et al. Association between atherogenic index of plasma and various metabolic conditions: An umbrella review on meta-analyses. BMC Cardiovascular Disorders. 2025;10.1186/s12872-025-05409-w. doi:10.1186/s12872-025-05409-w.

6. Hu Y, Liang Y, Li J, et al. Correlation between atherogenic index of plasma and cardiovascular disease risk across cardiovascular-kidney-metabolic syndrome stages 0-3: A nationwide prospective cohort study. Cardiovascular Diabetology. 2025;24(1):40. doi:10.1186/s12933-025-02593-z.

7. Kumar M, Zhao S, Robinson P, et al. Advancing age and risk from the elevated atherogenic index: Triglyceride (TG) to high-density cholesterol (HDL-C) ratio. Journal of the American Geriatrics Society. 2025. doi:10.1111/jgs.19607.

8. Won KB, Heo R, Park HB, et al. Atherogenic index of plasma and the risk of rapid progression of coronary atherosclerosis beyond traditional risk factors. Atherosclerosis. 2021;324:46-51. doi:10.1016/j.atherosclerosis.2021.03.009.

9. Li YW, Kao TW, Chang PK, Chen WL, Wu LW. Atherogenic index of plasma as predictors for metabolic syndrome, hypertension and diabetes mellitus in Taiwan citizens: A 9-year longitudinal study. Scientific Reports. 2021;11(1):9900. doi:10.1038/s41598-021-89307-z.

10. Gong S, Jin J, Mao J, et al. Plasma atherogenicity index is a powerful indicator for identifying metabolic syndrome in adults with type 2 diabetes mellitus: A cross-sectional study. Medicine. 2024;103(39):e39792. doi:10.1097/MD.0000000000039792.

11. Shin HR, Song S, Cho JA, Ly SY. Atherogenic index of plasma and its association with risk factors of coronary artery disease and nutrient intake in Korean adult men: The 2013-2014 KNHANES. Nutrients. 2022;14(5):1071. doi:10.3390/nu14051071.

12. Soheilifard S, Faramarzi E, Mahdavi R. Relationship between dietary intake and atherogenic index of plasma in cardiometabolic phenotypes: A cross-sectional study from the Azar cohort population. Journal of Health, Population, and Nutrition. 2025;44(1):28. doi:10.1186/s41043-025-00761-1.

13. Kim S, Shin MJ, Krauss RM. Dietary management of atherogenic dyslipidemia. Current Atherosclerosis Reports. 2025;27(1):93. doi:10.1007/s11883-025-01335-6.

14. Bajerska J, Skoczek-Rubińska A, Małczak L, et al. Plasma fatty acid composition and some markers of dietary habits are associated with cardiovascular disease risk determined by an atherogenic plasma index in postmenopausal women. Nutrition Research. 2023;115:47-60. doi:10.1016/j.nutres.2023.05.008.

15. Frondelius K, Borg M, Ericson U, et al. Lifestyle and dietary determinants of serum apolipoprotein A1 and apolipoprotein B concentrations: Cross-sectional analyses within a Swedish cohort of 24,984 individuals. Nutrients. 2017;9(3):E211. doi:10.3390/nu9030211.

16. Amani-Beni R, Darouei B, Mohammadifard N, et al. Exploring the association between healthy lifestyle score and atherogenic indices in a general population of Iranian adults. Lipids in Health and Disease. 2025;24(1):206. doi:10.1186/s12944-025-02631-5.

17. Niu Y, Chen X, Feng L. Can weekend warriors and other leisure-time physical activity patterns reduce the atherogenic index of plasma (AIP)? A cross-sectional analysis based on NHANES 2007-2018. Frontiers in Endocrinology. 2025;16:1511888. doi:10.3389/fendo.2025.1511888.

18. Edwards MK, Blaha MJ, Loprinzi PD. Influence of sedentary behavior, physical activity, and cardiorespiratory fitness on the atherogenic index of plasma. Journal of Clinical Lipidology. 2017;11(1):119-125. doi:10.1016/j.jacl.2016.10.014.

19. Zhang JS, Yeh WC, Tsai YW, Chen JY. The relationship between atherogenic index of plasma and obesity among adults in Taiwan. International Journal of Environmental Research and Public Health. 2022;19(22):14864. doi:10.3390/ijerph192214864.

20. Zalejska-Fiolka J, Hubková B, Birková A, et al. Prognostic value of the modified atherogenic index of plasma during body mass reduction in Polish obese/overweight people. International Journal of Environmental Research and Public Health. 2018;16(1):E68. doi:10.3390/ijerph16010068.

21. Shen S, Lu Y, Dang Y, et al. Effect of aerobic exercise on the atherogenic index of plasma in middle-aged Chinese men with various body weights. International Journal of Cardiology. 2017;230:1-5. doi:10.1016/j.ijcard.2016.12.132.

22. Weinstein S, Maor E, Kaplan A, et al. Non-interventional weight changes are associated with alterations in lipid profiles and in the triglyceride-to-HDL cholesterol ratio. Nutrients. 2024;16(4):486. doi:10.3390/nu16040486.

23. An P, Wan S, Luo Y, et al. Micronutrient supplementation to reduce cardiovascular risk. Journal of the American College of Cardiology. 2022;80(24):2269-2285. doi:10.1016/j.jacc.2022.09.048.

24. Casas R, Estruch R, Sacanella E. Influence of bioactive nutrients on the atherosclerotic process: A review. Nutrients. 2018;10(11):E1630. doi:10.3390/nu10111630.

25. Huang J, Frohlich J, Ignaszewski AP. The impact of dietary changes and dietary supplements on lipid profile. The Canadian Journal of Cardiology. 2011;27(4):488-505. doi:10.1016/j.cjca.2010.12.077.