Abstract
Background: Dyslipidemia is one of the modifiable risk factors for cardiovascular diseases (CVD). Identifying subjects with lipid abnormality facilitates preventative interventions.Objectives: To evaluate the effects of lipid indices on the risks of ischemic stroke (IS), coronary heart disease (CHD), CVD, all-cause death, and CVD death.Methods: The cohort study of 4,128 subjects started in May 2009 and followed up to July 2020. Restricted cubic spline (RCS) regression analysis was used to explore the dose-response relationship between lipid indices with outcomes. Cox proportional hazard regression analysis was used to estimate the association with a hazard ratio (HR) and 95% CI.Results: RCS analysis showed that there were significant linear associations of TG with IS, non-high-density lipoprotein cholesterol (HDL-C), apolipoprotein B (ApoB), and total cholesterol (TC)/HDL-C ratio with all-cause death, non-HDL-C and RC with CVD death, and significant non-linear associations of ApoB with IS and CVD, TC, LDL-C, ApoAI, and TC/HDL-C ratio with CHD, and TC with all-cause death (all P <0.1). Cox regression analysis revealed that subjects with TC <155 mg/dl (vs. 155–184 mg/dl), > 185 mg/dl (vs. 155–184 mg/dl), and ApoB <0.7 g/l (vs. ≥0.7 g/l) had higher risks of CHD (P < 0.05), the adjusted HRs (95% CIs) were 1.933 (1.248–2.993), 1.561 (1.077–2.261), and 1.502 (1.01–2.234), respectively. Subjects with ApoAI > 2.1 g/l (vs. 1.6–2.1 g/l) and TG <80 mg/dl (vs. 80–177 mg/dl) had higher risks of CVD and all-cause death (P < 0.05), the adjusted HRs (95% CIs) were 1.476 (1.031–2.115) and 1.234 (1.002–1.519), respectively.Conclusions: Lower or higher levels of TC, higher level of ApoAI, and lower level of ApoB were associated with increased risks of CVD, and lower level of TG was associated with increased all-cause death. Maintaining optimal lipid levels would help to prevent CVD and reduce mortality.
Highlights
Cardiovascular disease remains a major cause of premature mortality and rising health care costs across the world [1]
Due to the limitation in using a single lipid index to evaluate the relationship between dyslipidemia and cardiovascular disease (CVD) events and all-cause mortality, some studies proposed that apolipoprotein B (ApoB), apolipoprotein AI (ApoAI), lipoprotein (a) [Lp(a)] or lipid ratios had an additional clinical value, and recommended to attach importance to the measurement of ApoB in clinical practice [11,12,13,14]
The Asia Pacific Cohort Studies Collaboration (APCSC) integrated 30 cohort studies found a positive association between total cholesterol (TC) and CVD events; each 1 mmol/l increased for TC level was associated with a 41% greater risk of coronary heart disease (CHD) incidence and 23% greater risk of IS incidence [20]
Summary
Cardiovascular disease remains a major cause of premature mortality and rising health care costs across the world [1]. It is necessary to evaluate the effect of lipid profiles on CVD and mortality, identify the high-risk population, and tailor risk reduction strategies. Two large-scale, prospective cohort studies indicated that the elevated levels of conventional lipids indices including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG), and the reduced level of high-density lipoprotein cholesterol (HDLC) contributed to the increased risk of CVD incidence [7, 8]. Due to the limitation in using a single lipid index to evaluate the relationship between dyslipidemia and CVD events and all-cause mortality, some studies proposed that apolipoprotein B (ApoB), apolipoprotein AI (ApoAI), lipoprotein (a) [Lp(a)] or lipid ratios had an additional clinical value, and recommended to attach importance to the measurement of ApoB in clinical practice [11,12,13,14].
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