The association between low-density and non-high-density lipoprotein cholesterol with incident cardiovascular disease among low-risk Iranians during 2 decades follow-up

Abstract

IntroductionTo examine the associations between low-density and non-high-density lipoprotein cholesterol (LDL-C and non-HDL-C, respectively) with incident cardiovascular disease (CVD) in low-risk subjects. Materials and methodsFrom a total of 2467 non-diabetic aged 40–70 years, free of CVD with LDL-C range 1.81 ≤ LDL-C < 4.91 mmol/L with 10-year atherosclerotic cardiovascular disease (ASCVD) risk < 7.5 %, the associations of LDL-C and non-HDL-C with incident CVD were assessed using multivariable Cox proportional hazard regression analyses adjusted for age, sex, body mass index, waist circumference, HDL-C, triglycerides, chronic kidney disease, current smoking, hypertension, and family history of CVD. ResultsDuring a median follow-up of 18 years, 559 CVD events occurred. Compared to the LDL-C < 2.59 mmol/L as reference, the categories of 2.59 ≤ LDL-C < 3.36, 3.36 ≤ LDL-C < 4.14, and ≥ 4.14 mmol/L were associated with hazard ratios (95 % confidence intervals) of 1.39(0.89–2.18), 1.72(1.11–2.68), and 2.19(1.36–3.51) for incident CVD (P for trend <0.0001), respectively. Compared to the non-HDL-C < 3.36 as reference, the categories of 3.36 ≤ non-HDL-C < 4.14, 4.14 ≤ non-HDL-C < 4.91, and ≥ 4.91 mmol/L were associated with 1.48(0.96–2.30), 1.37(0.89–2.16), and 2.15(1.36–3.39) higher risk for incident CVD (P for trend = 0.001), respectively. Among those with ASCVD score <5 % (n = 2070), even the 2.59 ≤ LDL-C < 3.36 mmol/L increased the risk for CVD [1.73(1.01–2.97)]. Results for non-HDL-C categories remained unchanged compared to those with ASCVD risk < 7.5%. ConclusionsAmong Iranian individuals with ASCVD risk as little as < 5 %, LDL-C ≥ 2.59 mmol/L and non-HDL-C ≥ 3.36 mmol/L, independent of traditional risk factors, were associated with a significantly higher risk of incident CVD, individuals that might potentially benefit from pharmacological therapy.