Abstract
BackgroundThe traditional view on the relationship between lipid biomarkers and CVD risk has changed during the last decade. However, it is not clear whether novel lipid biomarkers are able to confer a better predictability of CVD risk, compared to traditional ones.Under this perspective, the aim of the present work was to evaluate the predictive ability of blood lipids’ profile on all cause mortality as well as 10-year incidence of CVD, in a sample of apparently healthy adults of the ATTICA epidemiological study. MethodsFrom May 2001 to December 2002, 1514 men and 1528 women (>18 y) without any clinical evidence of any other chronic disease, at baseline, were enrolled. In 2011–12, the 10-year follow-up was performed in 2583 participants (85 % follow-up participation rate). Incidence of fatal or non-fatal CVD was defined according to WHO-ICD-10 criteria. Baseline serum blood lipids’ profile (Total-C, HDL-, non HDL-, LDL-cholesterol, triglycerides (TG), apolipoprotein (Apo)A1 and B, and lipoprotein–(a) levels were also measured.ResultsThe 10-year all-cause mortality rate was 5.7 % for men and 2.0 % for women (p = 0.55). The, 10-year CVD incidence was 19.7 % in men and 11.7 % in women (p < 0.001). Multi-adjusted analysis revealed that TC, non-HDL-C, TG and TG/HDL-C ratio, were independent predictors of all cause mortality (RR per 1 mg/dL or unit (95 % CI): 1.006 (1.000–1.013), 1.006 (1.000–1.013), 1.002 (1.000–1.004), 1.038 (1.001–1.077), respectively). Moreover, TC, HDL-, LDL-, non-HDL-cholesterol, TG, apoA1, TC/HDL-C and TG/HDL-C were independently associated with CVD risk. Among all lipid indices the ratio of apoB/apoA1 demonstrated the best correct reclassification ability, followed by non-HDL-C and TC/HDL-C ratio (continuous Net Reclassification Index 26.1 and 21.2 %, respectively).ConclusionElevated levels of lipid biomarkers are independently associated with all-cause mortality, as well as CVD risk. The ratio of apoB/apoA1, followed by non-HDL-C, demonstrated the best correct classification ability of the developed CVD risk models.
Highlights
The traditional view on the relationship between lipid biomarkers and Cardiovascular disease (CVD) risk has changed during the last decade
The distribution of causes of deaths was: 51.1 % were due to CVD (i.e., 42.2 % coronary heart disease (CHD), 4.4 % stroke and 4.4 % other CVD), 30.0 % were due to cancer, 7.8 % were due to infections, 6.7 % were accidents and the rest 4.4 % were due to other reasons not identified
Participants who developed a CVD event within the 10-year follow-up were older at baseline examination than subjects who remained free of the disease (p < 0.001), more likely to be men (p < 0.001), with lower educational status (p < 0.001), obese (p < 0.001) and they were away from the Mediterranean diet, as assessed with the MedDietScore (23 ± 7/55 vs. 26 ± 6/55, respectively, p < 0.001)
Summary
The traditional view on the relationship between lipid biomarkers and CVD risk has changed during the last decade. It is possible that people with a high content of elevated small dense lipoprotein particles have near normal LDL-C values due to the discordance between the apoB particle number and their cholesterol content. These people will have an underestimated risk prediction score [14]. It is obvious that the traditional view on the relationship between lipid biomarkers and CVD risk has changed during the last decade It is not clear whether novel lipid biomarkers (e.g., apoB, apoA1, Lp(a), non-HDL-C) are able to confer a better predictability of CVD risk, compared to the more traditional ones (LDL-C, HDL-C and TGs)
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