Preventive cardiology
Non–High-Density Lipoprotein and Very-Low-Density Lipoprotein Cholesterol and Their Risk Predictive Values in Coronary Heart Disease

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To determine if non–high-density lipoprotein (HDL) cholesterol is a more useful predictor of coronary heart disease (CHD) risk than low-density lipoprotein (LDL) cholesterol and if very-low-density lipoprotein (VLDL) cholesterol is an independent predictor of CHD risk, data from the Framingham Heart Study (2,693 men, 3,101 women) were used for this analysis. All subjects were aged ≥30 years and free of CHD at baseline, and incident CHD was the end point (618 men, 372 women). Cox proportional-hazards models were used to assess the risk for CHD (relative risks and 95% confidence intervals) on the basis of the joint distribution of LDL cholesterol and non-HDL cholesterol (in milligrams per deciliter), as well as LDL cholesterol, non-HDL cholesterol, and VLDL cholesterol as continuous variables. After multivariate adjustment, within non-HDL cholesterol level, no association was found between LDL cholesterol and the risk for CHD, whereas within LDL cholesterol levels, a strong positive and graded association between non-HDL cholesterol and risk for CHD was observed. When the analysis was repeated within triglyceride levels (<200 vs ≥200 mg/dl), the risk pattern did not change significantly. Also, VLDL cholesterol was found to be a significant predictor of CHD risk after adjusting for LDL cholesterol at triglyceride levels of ≥200 or <200 mg/dl. In conclusion, these results suggest that non-HDL cholesterol level is a stronger predictor of CHD risk than LDL cholesterol; that is, VLDL cholesterol may play a critical role in the development of CHD.

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Methods

The analytic samples from each of the cohorts were comparably defined (Table 1). The pooled sample consisted of men and women who were (1) aged ≥30 years, (2) free of CHD at baseline, and (3) known to have fasted overnight for ≥9 hours. Details about the design of the Framingham Heart Study are given elsewhere.1, 2

Results

A total of 5,794 subjects (2,693 men, 3,101 women) from the Framingham Cohort Study and the Framingham Offspring Study were pooled for analyses (Table 2). The average follow-up time was about 15 years. During the follow-up, a total of 990 incident CHD events (618 in men, 372 in women) were recorded. The CHD incidence rate was 107.0/10,000 subject–years (149.7 in men, 72.7 in women). All lipid parameters were strongly associated with CHD risk in men and women (Table 3). Because the results for

Discussion

The results from this study support the conclusions that VLDL cholesterol is an independent predictor of CHD risk and that non-HDL cholesterol overall appears to be a better predictor of CHD risk than LDL cholesterol. These conclusions appear to be valid for the entire population and when TG levels are either <200 or ≥200 mg/dl.

When introduced into a multivariate model individually, the increases in CHD risk associated with 1 mg/dl increases in the levels of non-HDL cholesterol and LDL

Acknowledgment

This report was prepared using a limited access data set obtained from the National Heart, Lung, and Blood Institute, Bethesda, Maryland, and does not necessarily reflect the opinions or views of the individual studies or the National Heart, Lung, and Blood Institute.

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  • Cited by (0)

    The Framingham Heart Study is conducted and supported by the National Heart, Lung, and Blood Institute, Bethesda, Maryland, in collaboration with the study investigators.

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