This Article Free upon publication Full Text Full Text (PDF) All Versions of this Article: 106/20/2537    most recent 01.CIR.0000038496.57570.06v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bittner, V. Articles by Sopko, G. Search for Related Content PubMed PubMed Citation Articles by Bittner, V. Articles by Sopko, G. Related Collections Chronic ischemic heart disease Related Article

(Circulation. 2002;106:2537.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

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; 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.).

Correspondence to Vera Bittner, MD, MSPH, University of Alabama at Birmingham, LHRB 310, 700 19th Street South, Birmingham, AL 35294 (E-mail vbittner{at}uab.edu). Reprint requests to BARI Coordinating Center, University of Pittsburgh, 127 Parran Hall, 130 DeSoto Street, Pittsburgh, PA 15261.

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

Related Article:

Low-Density Lipoprotein, Non-High-Density Lipoprotein, and Apolipoprotein B as Targets of Lipid-Lowering Therapy

Scott M. Grundy
Circulation 2002 106: 2526-2529. [Extract] [Full Text]

This article has been cited by other articles:

				F. Wiesbauer, H. Blessberger, D. Azar, G. Goliasch, O. Wagner, L. Gerhold, K. Huber, K. Widhalm, F. Abdolvahab, G. Sodeck, et al. Familial-combined hyperlipidaemia in very young myocardial infarction survivors (<=40 years of age) Eur. Heart J., May 1, 2009; 30(9): 1073 - 1079. [Abstract] [Full Text] [PDF]

				Y. Henkin Re-Evaluating Therapeutic Target Goals for Statin-Treated Patients: Time for Revolutionary Changes? J. Am. Coll. Cardiol., August 19, 2008; 52(8): 633 - 635. [Full Text] [PDF]

				J. J.P. Kastelein, W. A. van der Steeg, I. Holme, M. Gaffney, N. B. Cater, P. Barter, P. Deedwania, A. G. Olsson, S. M. Boekholdt, D. A. Demicco, et al. Lipids, Apolipoproteins, and Their Ratios in Relation to Cardiovascular Events With Statin Treatment Circulation, June 10, 2008; 117(23): 3002 - 3009. [Abstract] [Full Text] [PDF]

				M. G. Frontini, S. R. Srinivasan, J. Xu, R. Tang, M. G. Bond, and G. S. Berenson Usefulness of Childhood Non-High Density Lipoprotein Cholesterol Levels Versus Other Lipoprotein Measures in Predicting Adult Subclinical Atherosclerosis: The Bogalusa Heart Study Pediatrics, May 1, 2008; 121(5): 924 - 929. [Abstract] [Full Text] [PDF]

				M. Arca, B. Conti, A. Montali, P. Pignatelli, F. Campagna, F. Barilla, G. Tanzilli, R. Verna, A. Vestri, C. Gaudio, et al. C242T Polymorphism of NADPH Oxidase p22phox and Recurrence of Cardiovascular Events in Coronary Artery Disease Arterioscler Thromb Vasc Biol, April 1, 2008; 28(4): 752 - 757. [Abstract] [Full Text] [PDF]

				O. Y. Bang, J. L. Saver, D. S. Liebeskind, S. Pineda, and B. Ovbiagele Association of serum lipid indices with large artery atherosclerotic stroke Neurology, March 11, 2008; 70(11): 841 - 847. [Abstract] [Full Text] [PDF]

				A. L. Peters Clinical Relevance of Non-HDL Cholesterol in Patients With Diabetes Clin. Diabetes, January 1, 2008; 26(1): 3 - 7. [Abstract] [Full Text] [PDF]

				D. M. Bravata, A. L. Gienger, K. M. McDonald, V. Sundaram, M. V. Perez, R. Varghese, J. R. Kapoor, R. Ardehali, D. K. Owens, and M. A. Hlatky Systematic Review: The Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Graft Surgery Ann Intern Med, November 20, 2007; 147(10): 703 - 716. [Abstract] [Full Text] [PDF]

				S. R. Srinivasan, M. G. Frontini, J. Xu, and G. S. Berenson Utility of Childhood Non-High-Density Lipoprotein Cholesterol Levels in Predicting Adult Dyslipidemia and Other Cardiovascular Risks: The Bogalusa Heart Study Pediatrics, July 1, 2006; 118(1): 201 - 206. [Abstract] [Full Text] [PDF]

				The Diabetes and Nutrition Study Group of the Span Diabetes Nutrition and Complications Trial: Trends in nutritional pattern between 1993 and 2000 and targets of diabetes treatment in a sample of Spanish people with diabetes Diabetes Care, April 1, 2004; 27(4): 984 - 987. [Full Text] [PDF]

				M.J Chapman and M Caslake Non-high-density lipoprotein cholesterol as a risk factor: addressing risk associated with apolipoprotein B-containing lipoproteins Eur. Heart J. Suppl., March 1, 2004; 6(suppl_A): A43 - A48. [Abstract] [Full Text] [PDF]

				G. Bos, J. M. Dekker, and R. J. Heine Non-HDL Cholesterol Contributes to the "Hypertriglyceridemic Waist" as a Cardiovascular Risk Factor: The Hoorn Study Diabetes Care, January 1, 2004; 27(1): 283 - 284. [Full Text] [PDF]

				K. Stephenson, J. Tunstead, A. Tsai, R. Gordon, S. Henderson, and H. M. Dansky Neointimal Formation After Endovascular Arterial Injury Is Markedly Attenuated in db/db Mice Arterioscler Thromb Vasc Biol, November 1, 2003; 23(11): 2027 - 2033. [Abstract] [Full Text] [PDF]

				A. M. Wagner, A. Perez, E. Zapico, and J. Ordonez-Llanos Non-HDL Cholesterol and Apolipoprotein B in the Dyslipidemic Classification of Type 2 Diabetic Patients Diabetes Care, July 1, 2003; 26(7): 2048 - 2051. [Abstract] [Full Text] [PDF]

				S. M. Grundy Low-Density Lipoprotein, Non-High-Density Lipoprotein, and Apolipoprotein B as Targets of Lipid-Lowering Therapy Circulation, November 12, 2002; 106(20): 2526 - 2529. [Full Text] [PDF]