Matthew J. McQueen, MD, PhD; Allan Sniderman, MD
What effects do major lipids and apolipoproteins have on risk for cardiovascular disease (CVD)?
Individual patient data meta-analysis of 68 prospective cohort studies, nested case–control studies, and randomized controlled trials with a median 8 years of follow-up (Emerging Risk Factors Collaboration [ERFC]).
Mainly population-based studies, with 60% of participants from western Europe and 32% from North America.
302 430 adults (mean age 59 y, 57% men) with no history of CVD.
Serum levels of high-density lipoprotein cholesterol (HDL-C), non–HDL-C, triglycerides, apolipoprotein (apo) AI, and apo B.
Coronary heart disease (CHD) event (first ever myocardial infarction or fatal CHD) and ischemic stroke.
After adjustment for levels of the other major lipids and standard risk factors, risk for CHD increased with decreasing levels of HDL-C and increasing levels of non–HDL-C but was not affected by triglyceride level (Table). Hazard ratios were at least as strong in participants who did not fast before giving blood samples as in those who did. Risk for stroke was increased only with increasing levels of non–HDL-C (Table). In 22 studies (n = 91 307) in which both lipids and apolipoproteins were measured, hazard ratios for CHD were almost identical for non–HDL-C and apo B, for HDL-C and apo AI, and for total cholesterol/HDL-C and apo B/apo AI ratios. In 8 studies (n = 44 234) in which low-density lipoprotein cholesterol (LDL-C) levels were measured directly, the hazard ratio for CHD was similar to that obtained using calculated non–HDL-C levels.
Either cholesterol (total and high-density lipoprotein) levels or apolipoprotein levels can be used to determine risk for cardiovascular disease events. Triglyceride levels do not provide additional information. Patients do not need to fast before giving a blood sample.
Risk for cardiovascular disease events by serum levels of major lipids*
*HDL-C = high-density lipoprotein cholesterol.
†Per 1 standard deviation increase in lipid level. Adjusted for age, sex, systolic blood pressure, smoking, diabetes, body mass index, and levels of the other major lipids.
McQueen MJ, Sniderman A. Either cholesterol or apolipoprotein levels can be used to determine risk for CVD; triglycerides are not useful. Ann Intern Med. 2010;152:JC2–12. doi: 10.7326/0003-4819-152-4-201002160-02012
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Published: Ann Intern Med. 2010;152(4):JC2-12.
Cardiology, Coronary Risk Factors, Dyslipidemia.
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