Predictors of ischemic cardiovascular disease in middle-age Chinese with optimal low-density lipoprotein cholesterol

Abstract

Objectives To identify the risk factors of CHD and ischemic stroke in participants with optimal LDL-C compared with higher LDL-C. Design and methods In the Chinese Multi-provincial Cohort Study, 30,378 participants aged 35 to 64 and free of CVD were recruited from 11 provinces in China and followed up for 12 years. The risk factors of CHD and ischemic stroke were identified for participants with optimal (<100 mg/dl) LDL-C compared with higher LDL-C. Results Mean level of LDL-C was 106.7 mg/dl (±41.6) at baseline. Thirty-four percent of the ICVD events occurred from participants with optimal LDL-C. After adjusting for age and baseline LDL-C, central obesity and elevated triglycerides significantly predicted the incidence of CHD in participants with optimal LDL-C, but not in those with higher LDL-C. In contrast, diabetes, smoking, and male gender were significantly associated with CHD incidence in higher but not in the optimal LDL-C group. Hypertension was associated with a higher CHD risk in whole LDL-C spectrum, whereas low HDL-C was not associated with CHD in either LDL-C level independent of other risk factors. Similarly, central obesity was a significant risk factor of ischemic stroke in optimal but not in higher LDL-C group, while diabetes, smoking and male gender were risk factors of ischemic stroke in higher but not in optimal LDL-C group. Hypertension and low HDL-C were, but elevated triglycerides were not, significant predictors of ischemic stroke regardless of LDL-C level. Conclusions In this cohort, about 1/3 of the ICVD events occurred in participants with optimal LDL-C, so the intervention of other risk factors must be emphasized in this population. Intensive control of central obesity and elevated triglycerides would be especially important to further reduce the risk of ICVD in people with low LDL-C, whereas the management of diabetes and smoking merits enforcement in hypercholesterolemia patients. Objectives To identify the risk factors of CHD and ischemic stroke in participants with optimal LDL-C compared with higher LDL-C. Design and methods In the Chinese Multi-provincial Cohort Study, 30,378 participants aged 35 to 64 and free of CVD were recruited from 11 provinces in China and followed up for 12 years. The risk factors of CHD and ischemic stroke were identified for participants with optimal (<100 mg/dl) LDL-C compared with higher LDL-C. Results Mean level of LDL-C was 106.7 mg/dl (±41.6) at baseline. Thirty-four percent of the ICVD events occurred from participants with optimal LDL-C. After adjusting for age and baseline LDL-C, central obesity and elevated triglycerides significantly predicted the incidence of CHD in participants with optimal LDL-C, but not in those with higher LDL-C. In contrast, diabetes, smoking, and male gender were significantly associated with CHD incidence in higher but not in the optimal LDL-C group. Hypertension was associated with a higher CHD risk in whole LDL-C spectrum, whereas low HDL-C was not associated with CHD in either LDL-C level independent of other risk factors. Similarly, central obesity was a significant risk factor of ischemic stroke in optimal but not in higher LDL-C group, while diabetes, smoking and male gender were risk factors of ischemic stroke in higher but not in optimal LDL-C group. Hypertension and low HDL-C were, but elevated triglycerides were not, significant predictors of ischemic stroke regardless of LDL-C level. Conclusions In this cohort, about 1/3 of the ICVD events occurred in participants with optimal LDL-C, so the intervention of other risk factors must be emphasized in this population. Intensive control of central obesity and elevated triglycerides would be especially important to further reduce the risk of ICVD in people with low LDL-C, whereas the management of diabetes and smoking merits enforcement in hypercholesterolemia patients.