Abstract 13846: Non-High-Density Lipoprotein Cholesterol Levels vs Apoliprotein B or Apo B/Apo A 1 and Risk of Coronary Heart Disease Among Apparently Healthy Men and Women
Background Although Low-density lipoprotein cholesterol (LDL-C) is the primary target of lipid-lowering therapy, there is debate that apolipoprotein (Apo) B or Apo B/A-I may be a superior to non-high-density lipoprotein cholesterol (non-HDL-C) for coronary heart disease (CHD) risk assessment. This study compares the relative risk of CHD as it relates to non-HDL-C and Apo B or Apo B/A-I among healthy individuals with low LDL-C levels and additionally among individuals with low LDL-C and high C-reactive protein (CRP) levels.
Methods In the EPIC (European Prospective Investigation Into Cancer and Nutrition)-Norfolk prospective population study, 17,026 participants without diabetes or CHD between age 45 and 79 years were followed for 11.4± 2.8 years. A total of 2066 (12.1%) participants developed CHD during follow-up.
Results In a 195,692 person year follow up, risk of future CHD per 1 SD of LDL-C was 1.22 (95% confidence interval [CI]: 1.17 to 1.27), non-HDL-c 1.26 (95% CI 1.20-1.31), Apo B 1.19 (95% CI 1.14-1.24) and Apo B/A-I 1.12 (95% CI 1.09-1.15) respectively. Among individuals with low LDL-C levels (<100 mg/dl), after adjustment for age, sex, smoking, systolic blood pressure, waist circumference, physical activity, and hormone replacement therapy (in women), those in the highest quartile of non-HDL-C had a hazard ratio (HR) for future CHD of 1.99 (95% CI: 1.00 to 3.94) and 1.61 (95% CI: 1.10 to 2.34) for individuals with LDL-C < 130 mg/dl and CRP > 2. In a similar model, individuals in the highest quartile of Apo B had an HR of 1.30 (95% CI: 0.72 to 2.36) and 1.43 (95% CI: 1.00 to 2.05) for individuals with LDL-C < 130 mg/dl and CRP > 2. Individuals in the highest quartile of Apo B/A-I had an HR of 1.48 (95% CI: 0.78 to 2.78) and 1.69 (95% CI: 1.11 to 2.56) for individuals with LDL-C < 130 mg/dl and CRP > 2.
Conclusions In this prospective study, non-HDL-C correlated better with risk of future CHD when compared with Apo B and Apo B/A-I, especially among healthy individuals with low LDL-C and even among individuals with low LDL-C and high CRP levels. CHD risk assessment algorithms as well as lipid targets of lipid-lowering trials may also need to consider other easily available parameters such as non-HDL-C.
- © 2011 by American Heart Association, Inc.