Lipid-related markers and cardiovascular disease prediction.


Emerging Risk Factors Collaboration (Inc. Fletcher, A.E.), ; Di Angelantonio, E; Gao, P; Pennells, L; Kaptoge, S; Caslake, M; Thompson, A; Butterworth, AS; Sarwar, N; Wormser, D; Saleheen, D; Ballantyne, CM; Psaty, BM; Sundström, J; Ridker, PM; Nagel, D; Gillum, RF; Ford, I; Ducimetiere, P; Kiechl, S; Koenig, W; Dullaart, RP; Assmann, G; D'Agostino, RBSr; Dagenais, GR; Cooper, JA; Kromhout, D; Onat, A; Tipping, RW; Gómez-de-la-Cámara, A; Rosengren, A; Sutherland, SE; Gallacher, J; Fowkes, FG; Casiglia, E; Hofman, A; Salomaa, V; Barrett-Connor, E; Clarke, R; Brunner, E; Jukema, JW; Simons, LA; Sandhu, M; Wareham, NJ; Khaw, KT; Kauhanen, J; Salonen, JT; Howard, WJ; Nordestgaard, BG; Wood, AM; Thompson, SG; Boekholdt, SM; Sattar, N; Packard, C; Gudnason, V; Danesh, J; (2012) Lipid-related markers and cardiovascular disease prediction. JAMA , 307 (23). pp. 2499-506. ISSN 0098-7484 DOI: 10.1001/jama.2012.6571

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Abstract

CONTEXT The value of assessing various emerging lipid-related markers for prediction of first cardiovascular events is debated. OBJECTIVE To determine whether adding information on apolipoprotein B and apolipoprotein A-I, lipoprotein(a), or lipoprotein-associated phospholipase A2 to total cholesterol and high-density lipoprotein cholesterol (HDL-C) improves cardiovascular disease (CVD) risk prediction. DESIGN, SETTING, AND PARTICIPANTS Individual records were available for 165,544 participants without baseline CVD in 37 prospective cohorts (calendar years of recruitment: 1968-2007) with up to 15,126 incident fatal or nonfatal CVD outcomes (10,132 CHD and 4994 stroke outcomes) during a median follow-up of 10.4 years (interquartile range, 7.6-14 years). MAIN OUTCOME MEASURES Discrimination of CVD outcomes and reclassification of participants across predicted 10-year risk categories of low (<10%), intermediate (10%-<20%), and high (≥20%) risk. RESULTS The addition of information on various lipid-related markers to total cholesterol, HDL-C, and other conventional risk factors yielded improvement in the model's discrimination: C-index change, 0.0006 (95% CI, 0.0002-0.0009) for the combination of apolipoprotein B and A-I; 0.0016 (95% CI, 0.0009-0.0023) for lipoprotein(a); and 0.0018 (95% CI, 0.0010-0.0026) for lipoprotein-associated phospholipase A2 mass. Net reclassification improvements were less than 1% with the addition of each of these markers to risk scores containing conventional risk factors. We estimated that for 100,000 adults aged 40 years or older, 15,436 would be initially classified at intermediate risk using conventional risk factors alone. Additional testing with a combination of apolipoprotein B and A-I would reclassify 1.1%; lipoprotein(a), 4.1%; and lipoprotein-associated phospholipase A2 mass, 2.7% of people to a 20% or higher predicted CVD risk category and, therefore, in need of statin treatment under Adult Treatment Panel III guidelines. CONCLUSION In a study of individuals without known CVD, the addition of information on the combination of apolipoprotein B and A-I, lipoprotein(a), or lipoprotein-associated phospholipase A2 mass to risk scores containing total cholesterol and HDL-C led to slight improvement in CVD prediction.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Non-Communicable Disease Epidemiology
PubMed ID: 22797450
Web of Science ID: 305391400026
URI: http://researchonline.lshtm.ac.uk/id/eprint/1082589

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