Major lipids, apolipoproteins, and risk of vascular disease
Emerging Risk Factors Collaboration, Emanuele Di Angelantonio, Nadeem Sarwar, Philip Perry, Stephen Kaptoge, Kausik K Ray, Alexander Thompson, Angela M Wood, Sarah Lewington, Naveed Sattar, Chris J Packard, Rory Collins, Simon G Thompson, John Danesh, R W Tipping, C E Ford, S L Pressel, G Walldius, I Jungner, A R Folsom, L E Chambless, D B Panagiotakos, C Pitsavos, C Chrysohoou, C Stefanadis, M Knuiman, U Goldbourt, M Benderly, D Tanne, P H Whincup, S G Wannamethee, R W Morris, S Kiechl, J Willeit, P Santer, A Mayr, N Wald, S Ebrahim, D A Lawlor, J W G Yarnell, J Gallacher, E Casiglia, V Tikhonoff, P J Nietert, S E Sutherland, D L Bachman, J E Keil, M Cushman, B M Psaty, R P Tracy, A Tybjaerg-Hansen, B G Nordestgaard, M Benn, R Frikke-Schmidt, S Giampaoli, L Palmieri, S Panico, D Vanuzzo, L Pilotto, A Gómez de la Cámara, J A Gómez-Gerique, L Simons, J McCallum, Y Friedlander, F G R Fowkes, A J Lee, F B Smith, J Taylor, J M Guralnik, C L Phillips, R Wallace, J Guralnik, C L Phillips, D G Blazer, J M Guralnik, C L Phillips, C L Phillips, J M Guralnik, K-T Khaw, H Brenner, E Raum, H Müller, D Rothenbacher, J H Jansson, P Wennberg, A Nissinen, C Donfrancesco, S Giampaoli, V Salomaa, K Harald, P Jousilahti, E Vartiainen, M Woodward, R B D'Agostino, P A Wolf, R S Vasan, M J Pencina, E M Bladbjerg, T Jørgensen, L Møller, J Jespersen, R Dankner, A Chetrit, F Lubin, A Rosengren, L Wilhelmsen, G Lappas, H Eriksson, C Björkelund, L Lissner, C Bengtsson, P Cremer, D Nagel, R S Tilvis, T E Strandberg, B Rodriguez, J M Dekker, G Nijpels, C D A Stehouwer, E Rimm, J K Pai, S Sato, H Iso, A Kitamura, H Noda, U Goldbourt, J T Salonen, K Nyyssönen, T-P Tuomainen, D J H Deeg, J L Poppelaars, T W Meade, J A Cooper, B Hedblad, G Berglund, G Engstrom, W M M Verschuren, A Blokstra, A Döring, W Koenig, C Meisinger, W Mraz, W M M Verschure, A Blokstra, H Bas Bueno-de-Mesquita, L Wilhelmsen, A Rosengren, G Lappas, L H Kuller, G Grandits, R Selmer, A Tverdal, W Nystad, R Gillum, M Mussolino, E Rimm, S Hankinson, J Manson, J K Pai, V Salomaa, K Harald, P Jousilahti, E Vartiainen, T W Meade, J A Cooper, C Knottenbelt, J A Cooper, K A Bauer, S Sato, A Kitamura, Y Naito, H Iso, I Holme, R Selmer, A Tverdal, W Nystad, H Nakagawa, K Miura, P Ducimetiere, X Jouven, C J Crespo, M R Garcia Palmieri, P Amouyel, D Arveiler, A Evans, J Ferrieres, H Schulte, G Assmann, J Shepherd, C J Packard, N Sattar, I Ford, B Cantin, B Lamarche, J-P Després, G R Dagenais, E Barrett-Connor, D L Wingard, R Bettencourt, V Gudnason, T Aspelund, G Sigurdsson, B Thorsson, M Trevisan, J Witteman, I Kardys, M Breteler, A Hofman, H Tunstall-Pedoe, R Tavendale, G D O Lowe, M Woodward, B V Howard, Y Zhang, L Best, J Umans, Y Ben-Shlomo, G Davey-Smith, A Onat, T W Meade, I Njølstad, E B Mathiesen, M L Løchen, T Wilsgaard, E Ingelsson, L Lind, V Giedraitis, L Lannfelt, J M Gaziano, M Stampfer, P Ridker, J M Gaziano, P Ridker, H Ulmer, G Diem, H Concin, A Tosetto, F Rodeghiero, M Marmot, R Clarke, R Collins, A Fletcher, E Brunner, M Shipley, P Ridker, J Buring, J Shepherd, S M Cobbe, I Ford, M Robertson, Y He, A Marin Ibañez, E J M Feskens, D Kromhout, M Walker, S Watson, R Collins, E Di Angelantonio, S Erqou, S Kaptoge, S Lewington, L Orfei, L Pennells, P L Perry, K K Ray, N Sarwar, M Alexander, A Thompson, S G Thompson, M Walker, S Watson, F Wensley, I R White, A M Wood, J Danesh, Emerging Risk Factors Collaboration, Emanuele Di Angelantonio, Nadeem Sarwar, Philip Perry, Stephen Kaptoge, Kausik K Ray, Alexander Thompson, Angela M Wood, Sarah Lewington, Naveed Sattar, Chris J Packard, Rory Collins, Simon G Thompson, John Danesh, R W Tipping, C E Ford, S L Pressel, G Walldius, I Jungner, A R Folsom, L E Chambless, D B Panagiotakos, C Pitsavos, C Chrysohoou, C Stefanadis, M Knuiman, U Goldbourt, M Benderly, D Tanne, P H Whincup, S G Wannamethee, R W Morris, S Kiechl, J Willeit, P Santer, A Mayr, N Wald, S Ebrahim, D A Lawlor, J W G Yarnell, J Gallacher, E Casiglia, V Tikhonoff, P J Nietert, S E Sutherland, D L Bachman, J E Keil, M Cushman, B M Psaty, R P Tracy, A Tybjaerg-Hansen, B G Nordestgaard, M Benn, R Frikke-Schmidt, S Giampaoli, L Palmieri, S Panico, D Vanuzzo, L Pilotto, A Gómez de la Cámara, J A Gómez-Gerique, L Simons, J McCallum, Y Friedlander, F G R Fowkes, A J Lee, F B Smith, J Taylor, J M Guralnik, C L Phillips, R Wallace, J Guralnik, C L Phillips, D G Blazer, J M Guralnik, C L Phillips, C L Phillips, J M Guralnik, K-T Khaw, H Brenner, E Raum, H Müller, D Rothenbacher, J H Jansson, P Wennberg, A Nissinen, C Donfrancesco, S Giampaoli, V Salomaa, K Harald, P Jousilahti, E Vartiainen, M Woodward, R B D'Agostino, P A Wolf, R S Vasan, M J Pencina, E M Bladbjerg, T Jørgensen, L Møller, J Jespersen, R Dankner, A Chetrit, F Lubin, A Rosengren, L Wilhelmsen, G Lappas, H Eriksson, C Björkelund, L Lissner, C Bengtsson, P Cremer, D Nagel, R S Tilvis, T E Strandberg, B Rodriguez, J M Dekker, G Nijpels, C D A Stehouwer, E Rimm, J K Pai, S Sato, H Iso, A Kitamura, H Noda, U Goldbourt, J T Salonen, K Nyyssönen, T-P Tuomainen, D J H Deeg, J L Poppelaars, T W Meade, J A Cooper, B Hedblad, G Berglund, G Engstrom, W M M Verschuren, A Blokstra, A Döring, W Koenig, C Meisinger, W Mraz, W M M Verschure, A Blokstra, H Bas Bueno-de-Mesquita, L Wilhelmsen, A Rosengren, G Lappas, L H Kuller, G Grandits, R Selmer, A Tverdal, W Nystad, R Gillum, M Mussolino, E Rimm, S Hankinson, J Manson, J K Pai, V Salomaa, K Harald, P Jousilahti, E Vartiainen, T W Meade, J A Cooper, C Knottenbelt, J A Cooper, K A Bauer, S Sato, A Kitamura, Y Naito, H Iso, I Holme, R Selmer, A Tverdal, W Nystad, H Nakagawa, K Miura, P Ducimetiere, X Jouven, C J Crespo, M R Garcia Palmieri, P Amouyel, D Arveiler, A Evans, J Ferrieres, H Schulte, G Assmann, J Shepherd, C J Packard, N Sattar, I Ford, B Cantin, B Lamarche, J-P Després, G R Dagenais, E Barrett-Connor, D L Wingard, R Bettencourt, V Gudnason, T Aspelund, G Sigurdsson, B Thorsson, M Trevisan, J Witteman, I Kardys, M Breteler, A Hofman, H Tunstall-Pedoe, R Tavendale, G D O Lowe, M Woodward, B V Howard, Y Zhang, L Best, J Umans, Y Ben-Shlomo, G Davey-Smith, A Onat, T W Meade, I Njølstad, E B Mathiesen, M L Løchen, T Wilsgaard, E Ingelsson, L Lind, V Giedraitis, L Lannfelt, J M Gaziano, M Stampfer, P Ridker, J M Gaziano, P Ridker, H Ulmer, G Diem, H Concin, A Tosetto, F Rodeghiero, M Marmot, R Clarke, R Collins, A Fletcher, E Brunner, M Shipley, P Ridker, J Buring, J Shepherd, S M Cobbe, I Ford, M Robertson, Y He, A Marin Ibañez, E J M Feskens, D Kromhout, M Walker, S Watson, R Collins, E Di Angelantonio, S Erqou, S Kaptoge, S Lewington, L Orfei, L Pennells, P L Perry, K K Ray, N Sarwar, M Alexander, A Thompson, S G Thompson, M Walker, S Watson, F Wensley, I R White, A M Wood, J Danesh
Abstract
Context: Associations of major lipids and apolipoproteins with the risk of vascular disease have not been reliably quantified.
Objective: To assess major lipids and apolipoproteins in vascular risk.
Design, setting, and participants: Individual records were supplied on 302,430 people without initial vascular disease from 68 long-term prospective studies, mostly in Europe and North America. During 2.79 million person-years of follow-up, there were 8857 nonfatal myocardial infarctions, 3928 coronary heart disease [CHD] deaths, 2534 ischemic strokes, 513 hemorrhagic strokes, and 2536 unclassified strokes.
Main outcome measures: Hazard ratios (HRs), adjusted for several conventional factors, were calculated for 1-SD higher values: 0.52 log(e) triglyceride, 15 mg/dL high-density lipoprotein cholesterol (HDL-C), 43 mg/dL non-HDL-C, 29 mg/dL apolipoprotein AI, 29 mg/dL apolipoprotein B, and 33 mg/dL directly measured low-density lipoprotein cholesterol (LDL-C). Within-study regression analyses were adjusted for within-person variation and combined using meta-analysis.
Results: The rates of CHD per 1000 person-years in the bottom and top thirds of baseline lipid distributions, respectively, were 2.6 and 6.2 with triglyceride, 6.4 and 2.4 with HDL-C, and 2.3 and 6.7 with non-HDL-C. Adjusted HRs for CHD were 0.99 (95% CI, 0.94-1.05) with triglyceride, 0.78 (95% CI, 0.74-0.82) with HDL-C, and 1.50 (95% CI, 1.39-1.61) with non-HDL-C. Hazard ratios were at least as strong in participants who did not fast as in those who did. The HR for CHD was 0.35 (95% CI, 0.30-0.42) with a combination of 80 mg/dL lower non-HDL-C and 15 mg/dL higher HDL-C. For the subset with apolipoproteins or directly measured LDL-C, HRs were 1.50 (95% CI, 1.38-1.62) with the ratio non-HDL-C/HDL-C, 1.49 (95% CI, 1.39-1.60) with the ratio apo B/apo AI, 1.42 (95% CI, 1.06-1.91) with non-HDL-C, and 1.38 (95% CI, 1.09-1.73) with directly measured LDL-C. Hazard ratios for ischemic stroke were 1.02 (95% CI, 0.94-1.11) with triglyceride, 0.93 (95% CI, 0.84-1.02) with HDL-C, and 1.12 (95% CI, 1.04-1.20) with non-HDL-C.
Conclusion: Lipid assessment in vascular disease can be simplified by measurement of either total and HDL cholesterol levels or apolipoproteins without the need to fast and without regard to triglyceride.
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Source: PubMed