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.
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Article info
Publication history
Published online: July 08, 2013
Accepted:
May 25,
2013
Received in revised form:
May 25,
2013
Received:
March 25,
2013
Footnotes
This study was supported in part by grants-in-aid from the scientific research fund of the Ministry of Education, Science, and Culture of Japan (23591059), Tokyo, Japan; the Japan Arteriosclerosis Prevention Fund (JAPF), Tokyo, Japan; and the Takeda Science Foundation, Osaka, Japan.
See page 1067 for disclosure information.
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© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
