Advertisement

Predictive Value of Lipoprotein Indices for Residual Risk of Acute Myocardial Infarction and Sudden Death in Men With Low-Density Lipoprotein Cholesterol Levels <120 mg/dl

      Several epidemiologic studies have demonstrated that plasma low-density lipoprotein cholesterol (LDL-C) profile is a key risk indicator for coronary heart disease (CHD). However, almost half of all patients with CHD have normal LDL-C levels. A total of 7,931 male subjects aged ≥40 years from the general population with no cardiovascular history and no use of lipid-lowering agents were followed for incidence of acute myocardial infarction (AMI) and sudden death. Of the 4,827 participants with LDL-C levels <120 mg/dl, 55 subjects had a first AMI/sudden death during an average of 5.5 years of follow-up. After adjustment for confounding factors, multiadjusted hazard ratios (HRs) were increased by 1 SD for non-high-density lipoprotein cholesterol (non-HDL-C; HR = 1.36, 95% confidence interval [CI], 1.02 to 1.81), total cholesterol (TC)/HDL-C ratio (HR = 1.40, 95% CI: 1.11 to 1.78) and LDL-C/HDL-C ratio (HR = 1.32, 95% CI: 1.02 to 1.73) but not for LDL-C (HR = 1.09, 95% CI: 0.82 to 1.44) and HDL-C (HR = 0.84, 95% CI: 0.68 to 1.04). When stratified as categorical variables on the basis of points with highest accuracy on receiver operating characteristic analysis, non-HDL-C levels >126 mg/dl (HR = 1.25, 95% CI: 1.03 to 1.51), TC/HDL-C ratio above 3.5 (HR = 1.22, 95% CI: 1.01 to 1.48) and LDL-C/HDL-C ratio >1.9 (HR = 1.25, 95% CI: 1.04 to 1.51) had increased multiadjusted HRs for AMI/sudden death. In conclusion, in men with LDL-C levels <120 mg/dl, non HDL-C, TC/HDL-C, and LDL-C/HDL-C ratios have predictive value for residual risk of AMI/sudden death.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Wilson P.W.
        • D'Agostino R.B.
        • Levy D.
        • Belanger A.M.
        • Silbershatz H.
        • Kannel W.B.
        Prediction of coronary heart disease using risk factor categories.
        Circulation. 1998; 97: 1837-1847
        • Heart Protection Study Collaborative Group
        MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial.
        Lancet. 2002; 360: 7-22
        • Rubins H.B.
        • Robins S.J.
        • Collins D.
        • Iranmanesh A.
        • Wilt T.J.
        • Mann D.
        • Mayo-Smith M.
        • Faas F.H.
        • Elam M.B.
        • Rutan G.H.
        • Anderson J.W.
        • Kashyap M.L.
        • Schectman G.
        Distribution of lipids in 8,500 men with coronary artery disease. Department of Veterans Affairs HDL Intervention Trial Study Group.
        Am J Cardiol. 1995; 75: 1196-1201
        • National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)
        Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report.
        Circulation. 2002; 106: 3143-3421
        • Ingelsson E.
        • Schaefer E.J.
        • Contois J.H.
        • McNamara J.R.
        • Sullivan L.
        • Keyes M.J.
        • Pencina M.J.
        • Schoonmaker C.
        • Wilson P.W.
        • D'Agostino R.B.
        • Vasan R.S.
        Clinical utility of different lipid measures for prediction of coronary heart disease in men and women.
        JAMA. 2007; 298: 776-785
        • Okamura T.
        • Kokubo Y.
        • Watanabe M.
        • Higashiyama A.
        • Miyamoto Y.
        • Yoshimasa Y.
        • Okayama A.
        Low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol and the incidence of cardiovascular disease in an urban Japanese cohort study: the Suita study.
        Atherosclerosis. 2009; 203: 587-592
        • Natarajan S.
        • Glick H.
        • Criqui M.
        • Horowitz D.
        • Lipsitz S.R.
        • Kinosian B.
        Cholesterol measures to identify and treat individuals at risk for coronary heart disease.
        Am J Prev Med. 2003; 25: 50-57
        • Arsenault B.J.
        • Rana J.S.
        • Stroes E.S.
        • Després J.P.
        • Shah P.K.
        • Kastelein J.J.
        • Wareham N.J.
        • Boekholdt S.M.
        • Khaw K.T.
        Beyond low-density lipoprotein cholesterol: respective contributions of non-high-density lipoprotein cholesterol levels, triglycerides, and the total cholesterol/high-density lipoprotein cholesterol ratio to coronary heart disease risk in apparently healthy men and women.
        J Am Coll Cardiol. 2009; 55: 35-41
        • Ohsawa M.
        • Itai K.
        • Tanno K.
        • Onoda T.
        • Ogawa A.
        • Nakamura M.
        • Kuribayashi T.
        • Yoshida Y.
        • Kawamura K.
        • Sasaki S.
        • Sakata K.
        • Okayama A.
        Cardiovascular risk factors in the Japanese northeastern rural population.
        Int J Cardiol. 2009; 137: 226-235
        • Tunstall-Pedoe H.
        • Kuulasmaa K.
        • Amouyel P.
        • Arveiler D.
        • Rajakangas A.M.
        • Pajak A.
        Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents.
        Circulation. 1994; 90: 583-612
        • Nakamura M.
        • Sato S.
        • Shimamoto T.
        Improvement in Japanese clinical laboratory measurements of total cholesterol and HDL-cholesterol by the US Cholesterol Reference Method Laboratory Network.
        J Atheroscler Thromb. 2003; 10: 145-153
        • Matsuo S.
        • Imai E.
        • Horio M.
        • Yasuda Y.
        • Tomita K.
        • Nitta K.
        • Yamagata K.
        • Tomino Y.
        • Yokoyama H.
        • Hishida A.
        • Collaborators developing the Japanese equation for estimated GFR
        Revised equations for estimated GFR from serum creatinine in Japan.
        Am J Kidney Dis. 2009; 53: 982-992
        • Teramoto T.
        • Sasaki J.
        • Ishibashi S.
        • Birou S.
        • Daida H.
        • Dohi S.
        • Egusa G.
        • Hiro T.
        • Hirobe K.
        • Iida M.
        • Kihara S.
        • Kinoshita M.
        • Maruyama C.
        • Ohta T.
        • Okamura T.
        • Yamashita S.
        • Yokode M.
        • Yokote K.
        Executive Summary of the Japan Atherosclerosis Society (JAS) guidelines for the diagnosis and prevention of atherosclerotic cardiovascular diseases in Japan—2012 Version.
        J Atheroscler Thromb. 2013; 20: 517-523
        • Frost P.H.
        • Davis B.R.
        • Burlando A.J.
        • Curb J.D.
        • Guthrie Jr., G.P.
        • Isaacsohn J.L.
        • Wassertheil-Smoller S.
        • Wilson A.C.
        • Stamler J.
        Serum lipids and incidence of coronary heart disease. Findings from the Systolic Hypertension in the Elderly Program (SHEP).
        Circulation. 1996; 94: 2381-2388
        • Kitamura A.
        • Noda H.
        • Nakamura M.
        • Kiyama M.
        • Okada T.
        • Imano H.
        • Ohira T.
        • Sato S.
        • Yamagishi K.
        • Iso H.
        Association between non-high-density lipoprotein cholesterol levels and the incidence of coronary heart disease among Japanese: the Circulatory Risk in Communities Study (CIRCS).
        J Atheroscler Thromb. 2011; 18: 454-463
        • Farwell W.R.
        • Sesso H.D.
        • Buring J.E.
        • Gaziano J.M.
        Non-high-density lipoprotein cholesterol versus low-density lipoprotein cholesterol as a risk factor for a first nonfatal myocardial infarction.
        Am J Cardiol. 2005; 96: 1129-1134
        • Cui Y.
        • Blumenthal R.S.
        • Flaws J.A.
        • Whiteman M.K.
        • Langenberg P.
        • Bachorik P.S.
        • Bush T.L.
        Non-high-density lipoprotein cholesterol level as a predictor of cardiovascular disease mortality.
        Arch Intern Med. 2001; 161: 1413-1419
        • Liu J.
        • Sempos C.T.
        • Donahue R.P.
        • Dorn J.
        • Trevisan M.
        • Grundy S.M.
        Non-high-density lipoprotein and very-low-density lipoprotein cholesterol and their risk predictive values in coronary heart disease.
        Am J Cardiol. 2006; 98: 1363-1368
        • Yokokawa H.
        • Yasumura S.
        • Tanno K.
        • Ohsawa M.
        • Onoda T.
        • Itai K.
        • Sakata K.
        • Kawamura K.
        • Tanaka F.
        • Yoshida Y.
        • Nakamura M.
        • Terayama Y.
        • Ogawa A.
        • Okayama A.
        Serum low-density lipoprotein to high-density lipoprotein ratio as a predictor of future acute myocardial infarction among men in a 2.7-year cohort study of a Japanese northern rural population.
        J Atheroscler Thromb. 2011; 18: 89-98
        • Kinosian B.
        • Glick H.
        • Garland G.
        Cholesterol and coronary heart disease: predicting risks by levels and ratios.
        Ann Intern Med. 1994; 121: 641-647
        • Kitamura A.
        • Iso H.
        • Naito Y.
        • Iida M.
        • Konishi M.
        • Folsom A.R.
        • Sato S.
        • Kiyama M.
        • Nakamura M.
        • Sankai T.
        • Shimamoto T.
        • Komachi Y.
        High-density lipoprotein cholesterol and premature coronary heart disease in urban Japanese men.
        Circulation. 1994; 89: 2533-2539
        • Manolio T.A.
        • Pearson T.A.
        • Wenger N.K.
        • Barrett-Connor E.
        • Payne G.H.
        • Harlan W.R.
        Cholesterol and heart disease in older persons and women: review of NHLBI workshop.
        Ann Epidemiol. 1992; 2: 161-176
        • Frontini M.G.
        • Srinivasan S.R.
        • Xu J.H.
        • Tang R.
        • Bond M.G.
        • Berenson G.
        Utility of non-high-density lipoprotein cholesterol versus other lipoprotein measures in detecting subclinical atherosclerosis in young adults (The Bogalusa Heart Study).
        Am J Cardiol. 2007; 100: 64-68
        • Orakzai S.H.
        • Nasir K.
        • Blaha M.
        • Blumenthal R.S.
        • Raggi P.
        Non-HDL cholesterol is strongly associated with coronary artery calcification in asymptomatic individuals.
        Atherosclerosis. 2009; 202: 289-295
        • Kimm H.
        • Lee S.W.
        • Lee H.S.
        • Shim K.W.
        • Cho C.Y.
        • Yun J.E.
        • Jee S.H.
        Associations between lipid measures and metabolic syndrome, insulin resistance and adiponectin. Usefulness of lipid ratios in Korean men and women.
        Circ J. 2010; 74: 931-937
        • Tamada M.
        • Makita S.
        • Abiko A.
        • Naganuma Y.
        • Nagai M.
        • Nakamura M.
        Low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio as a useful marker for early-stage carotid atherosclerosis.
        Metabolism. 2010; 59: 653-657
        • Kimura T.
        • Itoh T.
        • Fusazaki T.
        • Matsui H.
        • Sugawara S.
        • Ogino Y.
        • Endo H.
        • Kobayashi K.
        • Nakamura M.
        Low-density lipoprotein-cholesterol/high-density lipoprotein-cholesterol ratio predicts lipid-rich coronary plaque in patients with coronary artery disease—integrated-backscatter intravascular ultrasound study.
        Circ J. 2010; 74: 1392-1398
        • Tanno K.
        • Okamura T.
        • Ohsawa M.
        • Onoda T.
        • Itai K.
        • Sakata K.
        • Nakamura M.
        • Ogawa A.
        • Kawamura K.
        • Okayama A.
        Comparison of low-density lipoprotein cholesterol concentrations measured by a direct homogeneous assay and by the Friedewald formula in a large community population.
        Clin Chim Acta. 2010; 411: 1774-1780
        • Rumana N.
        • Kita Y.
        • Turin T.C.
        • Murakami Y.
        • Sugihara H.
        • Morita Y.
        • Tomioka N.
        • Okayama A.
        • Nakamura Y.
        • Abbott R.D.
        • Ueshima H.
        Trend of increase in the incidence of acute myocardial infarction in a Japanese population: Takashima AMI Registry, 1990–2001.
        Am J Epidemiol. 2008; 167: 1358-1364