Clinical Utility of Different Lipid Measures for Prediction of Coronary Heart Disease in Men and Women.
From: Framingham Heart Study, 73 Mount Wayte Ave, Suite 2, Framingham, MA 01702-5803. vasan@bu.edu.
JAMA : the journal of the American Medical Association
- Publish Date: Aug 2007
- ISSN: 1538-3598
- Volume: 298
- Issue: 7
- Pages: 776-85
- Medium: Internet
- Language: English
- Citation (JAMA): Ingelsson Erik, Schaefer Ernst J, Contois John H, et al. Clinical Utility of Different Lipid Measures for Prediction of Coronary Heart Disease in Men and Women.. JAMA Aug 2007;298:776-85
Abstract
CONTEXT: Evidence is conflicting regarding the performance of apolipoproteins vs traditional lipids for predicting coronary heart disease (CHD) risk. OBJECTIVES: To compare performance of different lipid measures for CHD prediction using discrimination and calibration characteristics and reclassification of risk categories; to assess incremental utility of apolipoproteins over traditional lipids for CHD prediction. DESIGN, SETTING, AND PARTICIPANTS: Population-based, prospective cohort from, Framingham, Massachusetts. We evaluated serum total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, apolipoprotein (apo) A-I and apo B, and 3 lipid ratios (total cholesterol:HDL-C, LDL-C:HDL-C, and apo B:apo A-I) in 3322 middle-aged white participants who attended the fourth offspring examination cycle (1987-1991) and were without cardiovascular disease. Fifty-three percent of the participants were women. MAIN OUTCOME MEASURE: Incidence of first CHD event (recognized or unrecognized myocardial infarction, angina pectoris, coronary insufficiency, or coronary heart disease death). RESULTS: After a median follow-up of 15.0 years, 291 participants, 198 of whom were men, developed CHD. In multivariate models adjusting for nonlipid risk factors, the apo B:apo A-I ratio predicted CHD (hazard ratio [HR] per SD increment, 1.39; 95% confidence interval [CI], 1.23-1.58 in men and HR, 1.40; 95% CI, 1.16-1.67 in women), but risk ratios were similar for total cholesterol:HDL-C (HR, 1.39; 95% CI, 1.22-1.58 in men and HR, 1.39; 95% CI, 1.17-1.66 in women) and for LDL-C:HDL-C (HR, 1.35; 95% CI, 1.18-1.54 in men and HR, 1.36; 95% CI 1.14-1.63 in women). In both sexes, models using the apo B:apo A-I ratio demonstrated performance characteristics comparable with but not better than that for other lipid ratios. The apo B:apo A-I ratio did not predict CHD risk in a model containing all components of the Framingham risk score including total cholesterol:HDL-C (P = .12 in men; P = .58 in women). CONCLUSIONS: In this large, population-based cohort, the overall performance of apo B:apo A-I ratio for prediction of CHD was comparable with that of traditional lipid ratios but did not offer incremental utility over total cholesterol:HDL-C. These data do not support measurement of apo B or apo A-I in clinical practice when total cholesterol and HDL-C measurements are available.
Mesh Headings (Keywords): Apolipoprotein A-I, Apolipoproteins, Apolipoproteins B, Cholesterol, HDL, Cholesterol, LDL, Coronary Disease, Female, Humans, Likelihood Functions, Lipids, Male, Middle Aged, Proportional Hazards Models, Prospective Studies, Risk Factors
Check for Full Text / PubMed Unique Identifier (PMID): 17699011
This abstract is part of PubMed, a service of the U.S. National Library of Medicine. PubMed includes more than 17 million citations from MEDLINE and other life science journals for biomedical articles. See Copyright and Disclaimers.
Linked medical terms appearing on this page are added by Healia to help readers find more information and are not part of the original PubMed document.
The data herein was last updated on July 8th, 2008 and may not reflect the most current and accurate data available from NLM.