Abstract
BackgroundUnderstanding the distinct patterns (trajectories) of variation in blood lipid levels before diagnosing cardiovascular disease (CVD) might carry important implications for improving disease prevention or treatment.MethodsWe investigated 14,373 participants (45.5% men) aged 45â84 from two large US prospective cohort studies with a median of 23 years follow-up. First, we jointly estimated developmental trajectories of lipid indices, including low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) concentrations using group-based multi-trajectory modeling. Then, the association of identified multi-trajectories with incident CVD, heart failure, and all-cause mortality were examined using Cox proportional hazard model.ResultsSeven distinct multi-trajectories were identified. The majority of participants (approximately 80%) exhibited decreasing LDL-C but rising TG levels and relatively stable HDL-C levels. Compared to the individuals with healthy and stable LDL-C, HDL-C, and TG levels, those in other groups were at significant risk of incident CVD after adjusting for other conventional risk factors. Individuals with the highest but decreasing LDL-C and borderline high and rising TG levels over time were at the highest risk than those in other groups with a 2.22-fold risk of CVD. Also, those with the highest and increased triglyceride levels over time, over optimal and decreasing LDL-C levels, and the lowest HDL-C profile had a nearly 1.84 times CVD risk. Even individuals in the multi-trajectory group with the highest HDL-C, optimal LDL-C, and optimal TG levels had a significant risk (HR, 1.45; 95% CI 1.02â2.08). Furthermore, only those with the highest HDL-C profile increased the risk of heart failure by 1.5-fold (95% CI 1.07â2.06).ConclusionsThe trajectories and risk of CVD identified in this study demonstrated that despite a decline in LDL-C over time, a significant amount of residual risk for CVD remains. These findings suggest the impact of the increasing trend of TG on CVD risk and emphasize the importance of assessing the lipid levels at each visit and undertaking potential interventions that lower triglyceride concentrations to reduce the residual risk of CVD, even among those with the optimal LDL-C level.
Highlights
Cardiovascular diseases (CVDs) remain the leading cause of death and a significant cause of disability worldwide, accounting for 17.9 million deaths per year or 31% of allKoohi et al J Transl Med (2021) 19:286 global deaths [1]
We revealed that compared with the individuals presenting with optimal and stable levels of these lipids across the life course, those in the other multi-trajectory groups were at an increased risk of incident CVD after adjusting for confounders
Numerous studies have been suggested the association of lipids with the risk of CVD, the trajectories we identified in this study provide new insights for the common progression of lipid indices that could be expected to be observed during the age of 45 to 84 years in relatively healthy adults
Summary
Cardiovascular diseases (CVDs) remain the leading cause of death and a significant cause of disability worldwide, accounting for 17.9 million deaths per year or 31% of allKoohi et al J Transl Med (2021) 19:286 global deaths [1]. Understanding the distinct patterns of variation in blood lipid levels before the diagnosis of CVD might carry important implications for improving disease prevention or treatment. Most of the evidence on the trends in lipid indices comes from comparing observed average lipid levels in sequential cross-sectional surveys, and only a few of these studies have investigated trends in the lipid indices within the same population [3, 9,10,11,12] Most of these investigations did not consider the correlation between lipids and assessed the trajectory of lipid indices separately [3, 10,11,12]. Understanding the distinct patterns (trajectories) of variation in blood lipid levels before diagnosing cardiovascular disease (CVD) might carry important implications for improving disease prevention or treatment
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