Low-Density Lipoprotein Cholesterol, Non–High-Density Lipoprotein Cholesterol, Triglycerides, and Apolipoprotein B and Cardiovascular Risk in Patients With Manifest Arterial Disease

M Johanneke Van Den Berg,Yolanda Van Der Graaf,Gert Jan De Borst,Frank L.J Visseren,R Van Petersen,B.G.F Van Dinther,A Algra,D.E Grobbee,G.E.H.M Rutten,L Jaap Kappelle,T Leiner,Hendrik M Nathoe

doi:10.1016/j.amjcard.2016.06.048

M Johanneke Van Den Berg, Yolanda Van Der Graaf + Show 10 more

Open Access

https://doi.org/10.1016/j.amjcard.2016.06.048

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Abstract

Low-density lipoprotein cholesterol (LDL-C) only partly represents the atherogenic lipid burden, and a growing body of evidence suggests that non-high-density lipoprotein cholesterol (non-HDL-C), triglycerides, and apolipoprotein B (apoB) are more accurate in estimating lipid-related cardiovascular disease risk. Our objective was to compare the relation among LDL-C, non-HDL-C, triglycerides, and apoB and the occurrence of future vascular events and mortality in patients with manifest arterial disease. This is a prospective cohort study of 7,216 patients with clinically manifest arterial disease in the Secondary Manifestations of Arterial Disease Study. Cox proportional hazard models were used to quantify the risk of major cardiovascular events (MACE; i.e., stroke, myocardial infarction, and vascular mortality) and all-cause mortality. Interaction was tested for type of vascular disease at inclusion. MACE occurred in 1,185 subjects during a median follow-up of 6.5years (interquartile range 3.4 to 9.9years). Adjusted hazard ratios (HRs) of MACEper 1 SD higher were for LDL-C (HR 1.15, 95% confidence interval [CI] 1.09 to 1.22), for non-HDL-C (HR 1.17, 95% CI 1.11 to 1.23), for log(triglycerides) (HR 1.12, 95% CI 1.06 to 1.19), and for apoB HR (1.12, 95% CI 0.99 to 1.28). The relation among LDL-C, non-HDL-C, and cardiovascular events was comparable in patients with cerebrovascular disease, coronary artery disease, or polyvascular disease and absent in those with aneurysm of abdominal aorta or peripheral artery disease. In conclusion, in patients with a history of cerebrovascular, coronary artery, or polyvascular disease, but not aneurysm of abdominal aorta or peripheral artery disease, higher levels of LDL-C and non-HDL-C are related to increased risk of future MACE and of comparable magnitude.

Highlights

Data were used from patients enrolled in the Second Manifestations of Arterial Disease (SMART) cohort
Because triglycerides levels had a skewed distribution, log transformation was applied, and to be able to compare effect sizes of lipid parameters, hazard ratios (HRs) were calculated per 1 standard deviation (1 SD) increase in Low-density lipoprotein cholesterol (LDL-C), non-HDL-C, log(triglycerides), and ApoB
After adjustment for confounding, 1 SD higher LDL-C, non-HDL-C, triglycerides, and apolipoprotein B (apoB) were related with higher risk of major cardiovascular events (MACE) (HR 1.15, 95% confidence intervals (CIs) 1.09 to 1.22 for LDL-C; HR 1.17, 95% CI 1.11 to 1.23 for non-HDL-C; HR 1.12, 95% CI 1.06 to 1.19 for log(triglycerides); and HR 1.12, 95% CI 0.99 to 1.27 for apoB) and with increased risk of all-cause mortality, as presented in Figure 1

Summary

Introduction

Patients, aged 18 to 80 years, newly referred to our institution with clinically manifest arterial disease or with a vascular risk factor, www.ajconline.org All patients completed a health questionnaire and responded to questions including history of vascular disease, hypertension, diabetes mellitus, current medication use, and lifestyle.

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