How it all started

The AMORIS (Apolipoprotein-related MOrtality RISk) cohort includes subjects who underwent health examinations during the period 1985-1996 and where blood or urine samples were analysed at the Central Automation Laboratory (CALAB) in Stockholm, Sweden.

The cohort was assembled originally to study the importance of apolipoproteins B (atherogenic) and A-I (anti-atherogenic) as new and improved risk markers than conventional lipids. This original research theme was initiated by Ingmar Jungner, CALAB laboratory and Göran Walldius, King Gustaf V research institute at Karolinska institutet, Stockholm, Sweden. Today the AMORIS cohort consists of 812,073 subjects and is used for a broad range of clinical and epidemiologic research questions.

The CALAB laboratory

The CALAB laboratory was started by the two brothers Gunnar and Ingmar Jungner in 1961. They were world leading pioneers in developing multichannel automation technologies in order to increase the number of samples that can be analyzed in one day as well as in that samples can be analyzed also during night time. Over the years, they invented and upgraded the AutoChemist (C) in close collaboration with industry (AGA, Sweden) which made it possible to analyze 20 to 32 and up to 64 different types of analyses in each panel of laboratory samples. CALAB were also pioneers in using digital data analytical instrumentation connected to the automated systems.

Initially, during 1960-1970, there was much objection from health care providers to use automated techniques in health care, especially in open ward conditions, but gradually the clinical society found these techniques very useful. CALAB developed the analytic procedures to perfection both regarding sensitivity, specificity and stability at low costs according to international quality control and blinded testing protocols. The analytical technologies at CALAB were much appreciated by referring physicians and their capacity made it possible to screen large populations participating in health check-ups during the 1980s and 1990s.

In 1996, CALAB was sold to another company but the primary inventor and researcher Ingmar Jungner [HN1] was given the opportunity to use the laboratory database, comprising over 38 million analyses, for future scientific research. In 2012, Jungner donated the database to the Institute for Environmental Medicine (IMM), Karolinska institutet. This donation has given the opportunity to further develop and use the AMORIS cohort for clinical and epidemiologic research with a basis at Karolinska Institutet.

Early clinical studies based on the AMORIS cohort and collaborations

During the last two decades several research questions have been addressed using the AMORIS cohort. As mentioned above, the initial strategy was to investigate the role of apolipoproteins (apo) B and A-I in subjects with different types of hyper- and dyslipidemias. The overall hypothesis and long term goal was to provide evidence that apoB, apoA-I, and especially the apoB/apoA-I ratio were better and stronger predictors of cardiovascular risk than conventional lipids like LDL-cholesterol (LDL-C) and HDL-cholesterol (HDL-C) or any lipid-based ratio. This research has been performed in collaboration with scientists from Norway, Canada and the United states and generated several publications.

In 2001, the first strong AMORIS data were presented in the Lancet, indicating that the apoB/apoA-I ratio was stronger than conventional lipids in predicting fatal myocardial infarction. In the following years, additional publications indicated that similar advantages for apolipoproteins were found also in assessment of the risk of fatal ischaemic stroke and heart failure. Additional metabolic and inflammatory risk factors related to cardiovascular morbidity and mortality have been published based on the AMORIS cohort.

In 2005, the Steering group for AMORIS started to collaborate with scientists from Belgium, United Kingdom and Sweden to investigate the role of metabolic and inflammatory risk factors for the development of various forms of cancer. Subsequently, the research based on the AMORIS cohort has been extended to several disease areas including diabetes, kidney disease and neurological disorders.

Over the last 12 years we have produced new important knowledge in a broad field of pathophysiological mechanisms and clinical diseases, see the list of publications.

Miranda Beck