Abstract 13902: Gender Differences in Lipoprotein Parameters in Cardiovascular Disease Risk; The Framingham Offspring Study

Abstract

Introduction: Elevated serum lipoprotein cholesterol levels have been considered as atherosclerosis cardiovascular disease (ASCVD) risk factors. However, gender differences among these lipoproteins have not become clear. Hypothesis: Our hypothesis was that gender differences exist with regard to serum lipoprotein cholesterol levels and the risk of ASCVD risk in the prospective Framingham Offspring Study. Methods: A total of 1300 men and 1676 women, none of whom had ASCVD at baseline, were followed for a median time of 16 years for new onset fatal or non fatal myocardial infarction or stroke, coronary angioplasty or bypass, or carotid or peripheral vascular surgery (302 of 1300 or 23.2% of men and 226 of 1676 or 13.5% of women developed). At baseline, standard risk factors including fasting total and high density lipoprotein (HDL) cholesterol, and triglycerides were assessed, as were direct, small dense, and large low density lipoprotein (LDL) cholesterol and LDL triglyceride (LDL-TG), remnant lipoprotein cholesterol and lipoprotein(a) were measured. Univariate and multivariate analyses were carried out to assess relationships to disease risk. Results: All parameters were associated with ASCVD risk on univariate analysis. On multivariate analysis after controlling for all standard risk factors (age, hypertension, use of anti-hypertensive medication, diabetes, smoking, total cholesterol, HDL cholesterol, and use of cholesterol lowering medication), only lipoprotein(a) was significant in men with a 1.26 hazard ratio (P = 0.009), while small dense LDL cholesterol and LDL-TG, but not lipoprotein(a), were significant risk factors in women (hazard ratios 1.65 and 1.35, P = 0.007 and 0.015, respectively). Using the pooled cohort equation, only lipoprotein(a) added significant risk information in men and only small dense LDL cholesterol and LDL-TG added significant risk information in women. Conclusions: Our data indicate that men are at significantly higher disease risk then women, and that elevated lipoprotein(a) is a significant independent ASCVD risk factor in men, while small dense LDL cholesterol and LDL-TG are significant independent ASCVD risk factors in women after controlling for all other standard cardiovascular disease risk factors.