Circulation. 2001;104:1108-1113
doi: 10.1161/hc3501.095214
doi: 10.1161/hc3501.095214
(Circulation. 2001;104:1108.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Coronary Heart Disease Prediction From Lipoprotein Cholesterol Levels, Triglycerides, Lipoprotein(a), Apolipoproteins A-I and B, and HDL Density Subfractions
The Atherosclerosis Risk in Communities (ARIC) Study
From the Epidemiology and Biometry Program, National Heart, Lung, and Blood Institute, Bethesda, Md (A.R.S., S.A.C., P.D.S.); the Department of Medicine, Baylor College of Medicine, Houston, Tex (C.M.B.); the School of Public Health, University of North Carolina, Chapel Hill (G.M.D.H., D.C.); and the Department of Laboratory Medicine, Landeskrankenanstalten Salzburg, Austria (W.P.).
Correspondence to A. Richey Sharrett, MD, NIH/NHLBI/DECA, Two Rockledge Centre, Room 8164, 6701 Rockledge Dr, MSC 7934, Bethesda, MD 20892-7934.
Background—— Despite consensus on the need for blood cholesterol reductions to prevent coronary heart disease (CHD), available evidence on optimal cholesterol levels or the added predictive value of additional lipids is sparse.
Methods and Results—— After 10 years follow-up of 12 339 middle-aged participants free of CHD in the Atherosclerosis Risk in Communities Study (ARIC), 725 CHD events occurred. The lowest incidence was observed in those at the lowest LDL cholesterol (LDL-C) quintile, with medians of 88 mg/dL in women and 95 mg/dL in men, and risk accelerated at higher levels, with relative risks (RRs) for the highest quintile of 2.7 in women and 2.5 in men. LDL-C, HDL-C, lipoprotein(a) [Lp(a)], and in women but not men, triglycerides (TG) were all independent CHD predictors, providing an RR, together with blood pressure, smoking, and diabetes, of 13.5 in women and 4.9 in men. Lp(a) was less significant in blacks than whites. Prediction was not enhanced by HDL-C density subfractions or apolipoproteins (apo) A-I or B. Despite strong univariate associations, apoB did not contribute to risk prediction in subgroups with elevated TG, with lower LDL-C, or with high apoB relative to LDL-C.
Conclusions—— Optimal LDL-C values are <100 mg/dL in both women and men. LDL-C, HDL-C, TG, and Lp(a), without additional apolipoproteins or lipid subfractions, provide substantial CHD prediction, with much higher RR in women than men.
Key Words: lipoproteins • apolipoproteins • coronary disease • follow-up studies
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K. Hoffmann, B.-C. Zyriax, H. Boeing, and E. Windler A dietary pattern derived to explain biomarker variation is strongly associated with the risk of coronary artery disease Am. J. Clinical Nutrition, September 1, 2004; 80(3): 633 - 640. [Abstract] [Full Text] [PDF]
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F. D. Fuchs, L. E. Chambless, A. R. Folsom, M. L. Eigenbrodt, B. B. Duncan, A. Gilbert, and M. Szklo Association between Alcoholic Beverage Consumption and Incidence of Coronary Heart Disease in Whites and Blacks: The Atherosclerosis Risk in Communities Study Am. J. Epidemiol., September 1, 2004; 160(5): 466 - 474. [Abstract] [Full Text] [PDF]
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N. Rifai, J. Ma, F. M. Sacks, P. M. Ridker, W. J. L. Hernandez, M. J. Stampfer, and S. M. Marcovina Apolipoprotein(a) Size and Lipoprotein(a) Concentration and Future Risk of Angina Pectoris with Evidence of Severe Coronary Atherosclerosis in Men: The Physicians' Health Study Clin. Chem., August 1, 2004; 50(8): 1364 - 1371. [Abstract] [Full Text] [PDF]
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P. M Ridker, N. J. Brown, D. E. Vaughan, D. G. Harrison, and J. L. Mehta Established and Emerging Plasma Biomarkers in the Prediction of First Atherothrombotic Events Circulation, June 29, 2004; 109(25_suppl_1): IV-6 - IV-19. [Full Text] [PDF]
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 F Hartgens, G Rietjens, H A Keizer, H Kuipers, and B H R Wolffenbuttel Effects of androgenic-anabolic steroids on apolipoproteins and lipoprotein (a) Br. J. Sports Med., June 1, 2004; 38(3): 253 - 259. [Abstract] [Full Text] [PDF]
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K. D Stark and B. J Holub Differential eicosapentaenoic acid elevations and altered cardiovascular disease risk factor responses after supplementation with docosahexaenoic acid in postmenopausal women receiving and not receiving hormone replacement therapy Am. J. Clinical Nutrition, May 1, 2004; 79(5): 765 - 773. [Abstract] [Full Text] [PDF]
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 H. W. Cohen, S. M. Hailpern, and M. H. Alderman Glucose-Cholesterol Interaction Magnifies Coronary Heart Disease Risk for Hypertensive Patients Hypertension, May 1, 2004; 43(5): 983 - 987. [Abstract] [Full Text] [PDF]
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L. J. Shaw, J. F. Lewis, M. A. Hlatky, W. A. Hsueh, S. F. Kelsey, R. Klein, T. A. Manolio, A. R. Sharrett, R. P. Tracy, and Endorsed by the American College of Cardiology Fou Women's Ischemic Syndrome Evaluation: Current Status and Future Research Directions: Report of the National Heart, Lung and Blood Institute Workshop: October 2-4, 2002: Section 5: Gender-Related Risk Factors for Ischemic Heart Disease Circulation, February 17, 2004; 109 (6): e56 - e58. [Full Text] [PDF]
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L. Djousse, S. C Hunt, D. K Arnett, M. A Province, J. H Eckfeldt, and R C. Ellison Dietary linolenic acid is inversely associated with plasma triacylglycerol: the National Heart, Lung, and Blood Institute Family Heart Study Am. J. Clinical Nutrition, December 1, 2003; 78(6): 1098 - 1102. [Abstract] [Full Text] [PDF]
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S. M. Marcovina, M. L. Koschinsky, J. J. Albers, and S. Skarlatos Report of the National Heart, Lung, and Blood Institute Workshop on Lipoprotein(a) and Cardiovascular Disease: Recent Advances and Future Directions Clin. Chem., November 1, 2003; 49(11): 1785 - 1796. [Abstract] [Full Text] [PDF]
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 Asia Pacific Cohort Studies Collaboration Cholesterol, coronary heart disease, and stroke in the Asia Pacific region Int. J. Epidemiol., August 1, 2003; 32(4): 563 - 572. [Abstract] [Full Text] [PDF]
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R. A. Barkley, A. C. Brown, C. L. Hanis, S. L. Kardia, S. T. Turner, and E. Boerwinkle Lack of genetic linkage evidence for a trans-acting factor having a large effect on plasma lipoprotein[a] levels in African Americans J. Lipid Res., July 1, 2003; 44(7): 1301 - 1305. [Abstract] [Full Text] [PDF]
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S. Davison and S. R. Davis New Markers for Cardiovascular Disease Risk in Women: Impact of Endogenous Estrogen Status and Exogenous Postmenopausal Hormone Therapy J. Clin. Endocrinol. Metab., June 1, 2003; 88(6): 2470 - 2478. [Abstract] [Full Text] [PDF]
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C.J. Packard Apolipoproteins: the new prognostic indicator? Eur. Heart J. Suppl., June 1, 2003; 5(suppl_D): D9 - D16. [Abstract] [PDF]
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C.M. Ballantyne Raising high-density lipoprotein cholesterol: where are we now? Eur. Heart J. Suppl., June 1, 2003; 5(suppl_D): D17 - D25. [Abstract] [PDF]
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S. Johansson, L. Wilhelmsen, G. Lappas, and A. Rosengren High lipid levels and coronary disease in women in Goteborg--outcome and secular trends: a prospective 19 year follow-up in the BEDAstudy Eur. Heart J., April 2, 2003; 24(8): 704 - 716. [Abstract] [Full Text] [PDF]
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E. Shahar, L. E. Chambless, W. D. Rosamond, L. L. Boland, C. M. Ballantyne, P. G. McGovern, and A. R. Sharrett Plasma Lipid Profile and Incident Ischemic Stroke: The Atherosclerosis Risk in Communities (ARIC) Study Stroke, March 1, 2003; 34(3): 623 - 631. [Abstract] [Full Text] [PDF]
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A. D. Mooradian Cardiovascular Disease in Type 2 Diabetes Mellitus: Current Management Guidelines Arch Intern Med, January 13, 2003; 163(1): 33 - 40. [Abstract] [Full Text] [PDF]
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 Y. J. Woo and T. J. Gardner Myocardial Revascularization with Cardiopulmonary Bypass Card. Surg. Adult, January 1, 2003; 2(2003): 581 - 607. [Full Text]
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P. J. Talmud, E. Hawe, G. J. Miller, and S. E. Humphries Nonfasting Apolipoprotein B and Triglyceride Levels as a Useful Predictor of Coronary Heart Disease Risk in Middle-Aged UK Men Arterioscler Thromb Vasc Biol, November 1, 2002; 22(11): 1918 - 1923. [Abstract] [Full Text] [PDF]
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G. Schillaci, M. Pirro, E. Mannarino, A. R. Sharrett, S. A. Coady, P. D. Sorlie, C. M. Ballantyne, G. Heiss, D. Catellier, and W. Patsch Serum Triglyceride Concentration and Coronary Heart Disease Response Circulation, February 26, 2002; 105 (8): e54 - e54. [Full Text] [PDF]
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