Published Online
on October 21, 2002

A more recent version of this article appeared on November 12, 2002

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Submitted on June 21, 2002
Revised on August 28, 2002
Accepted on September 2, 2002

Non-High-Density Lipoprotein Cholesterol Levels Predict Five-Year Outcome in the Bypass Angioplasty Revascularization Investigation (BARI)

Vera Bittner MD, MSPH^*, Regina Hardison MS, Sheryl F. Kelsey PhD, Bonnie H. Weiner MD, Alice K. Jacobs MD, and George Sopko MD

From the University of Alabama at Birmingham (V.B.); the University of Pittsburgh, Pittsburgh, Pa (R.H., S.F.K.); the University of Massachusetts, Worchester (B.H.W.); Boston University, Boston, Mass (A.K.J.); and the National Heart, Lung, and Blood Institute, Bethesda, Md (G.S.).

^* To whom correspondence should be addressed. E-mail: vbittner{at}uab.edu.

Background—Current National Cholesterol Education Program guidelines recommend that non-high-density lipoprotein cholesterol (non-HDL-C) be considered a secondary target of therapy among individuals with triglycerides >2.26 mmol/L. It is not known whether non-HDL-C relates to prognosis among patients with coronary heart disease.

Methods and Results—Lipid levels were available at baseline among 1514 patients (73% men; mean age, 61 years) enrolled in the Bypass Angioplasty Revascularization Investigation (BARI); all had multivessel coronary artery disease. Patients were followed for 5 years. Outcomes of death, nonfatal myocardial infarction, and death or myocardial infarction were modeled using univariate and multivariate time-dependent proportional hazards methods; angina pectoris at 5 years was modeled using univariate and multivariate logistic regression. Non-HDL-C was a strong and independent predictor of nonfatal myocardial infarction (multivariate relative risk, 1.049 [95% confidence intervals, 1.006 to 1.093] for every 0.26 mmol/L increase) and angina pectoris (multivariate odds ratio, 1.049 [95% confidence intervals, 1.004 to 1.096] for every 0.26 mmol/L increase), but it did not relate to mortality. HDL-C and LDL-C did not predict events during follow-up.

Conclusions—Among patients with lipid values in BARI, non-HDL-C is a strong and independent predictor of nonfatal myocardial infarction and angina pectoris at 5 years, even after consideration of powerful clinical variables. Our data suggest that non-HDL-C is an appropriate treatment target among patients with coronary heart disease.

Key words: lipids • cholesterol • coronary disease • prognosis

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