Abstract

IntroductionThe potential impact of targeting different components of an adverse lipid profile in populations with multiple cardiovascular risk factors is not completely clear. This study aims to assess the association between different components of the standard lipid profile with all-cause mortality and hospitalization due to cardiovascular events in a high-risk population.MethodsThis prospective registry included high risk adults over 30 years old free of cardiovascular disease (2008–2012). Diagnosis of hypertension, dyslipidemia or diabetes mellitus was inclusion criterion. Lipid biomarkers were evaluated. Primary endpoints were all-cause mortality and hospital admission due to coronary heart disease or stroke. We estimated adjusted rate ratios (aRR), absolute risk differences and population attributable risk associated with adverse lipid profiles.Results51,462 subjects were included with a mean age of 62.6 years (47.6% men). During an average follow-up of 3.2 years, 919 deaths, 1666 hospitalizations for coronary heart disease and 1510 hospitalizations for stroke were recorded. The parameters that showed an increased rate for total mortality, coronary heart disease and stroke hospitalization were, respectively, low HDL-Cholesterol: aRR 1.25, 1.29 and 1.23; high Total/HDL-Cholesterol: aRR 1.22, 1.38 and 1.25; and high Triglycerides/HDL-Cholesterol: aRR 1.21, 1.30, 1.09. The parameters that showed highest population attributable risk (%) were, respectively, low HDL-Cholesterol: 7.70, 11.42, 8.40; high Total/HDL-Cholesterol: 6.55, 12.47, 8.73; and high Triglycerides/HDL-Cholesterol: 8.94, 15.09, 6.92.ConclusionsIn a population with cardiovascular risk factors, HDL-cholesterol, Total/HDL-cholesterol and triglycerides/HDL-cholesterol ratios were associated with a higher population attributable risk for cardiovascular disease compared to other common biomarkers.

Highlights

  • The potential impact of targeting different components of an adverse lipid profile in populations with multiple cardiovascular risk factors is not completely clear

  • In a population with cardiovascular risk factors, HDL-cholesterol, Total/HDL-cholesterol and triglycerides/HDL-cholesterol ratios were associated with a higher population attributable risk for cardiovascular disease compared to other common biomarkers

  • Risk assessment tools to estimate the patient’s 10-year risk of developing cardiovascular disease (CVD) have become the cornerstone to identify high-risk people for primary prevention. Both the Framingham-based equations [2] and the European Systematic COronary Risk Evaluation (SCORE) algorithm [3], include total cholesterol and high density lipoprotein cholesterol (HDL-C) as the main lipid parameters

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Summary

Objectives

This study aims to assess the association between different components of the standard lipid profile with allcause mortality and hospitalization due to cardiovascular events in a high-risk population. The aim of the present study was to prospectively estimate and compare the attributable risk associated with several lipid markers for all-cause mortality and hospitalization due to CVD in participants with at least one of the three major cardiovascular risk factors: hypertension, diabetes or dyslipidemia, receiving usual care and participating in the ESCARVAL-RISK project [11] “EStudio CARdiometabolico VALenciano” in a Mediterranean population

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