Associations of major lipids and apolipoproteins with the risk of vascular disease
have not been reliably quantified.
To assess major lipids and apolipoproteins in vascular risk.
Individual records were supplied on 302,430 people without initial vascular disease
from 68 long-term prospective studies, mostly in Europe and North America. During
2.79 million person-years of follow-up, there were 8857 nonfatal myocardial infarctions,
3928 coronary heart disease [CHD] deaths, 2534 ischemic strokes, 513 hemorrhagic strokes,
and 2536 unclassified strokes.
Hazard ratios (HRs), adjusted for several conventional factors, were calculated for
1-SD higher values: 0.52 log(e) triglyceride, 15 mg/dL high-density lipoprotein cholesterol
(HDL-C), 43 mg/dL non-HDL-C, 29 mg/dL apolipoprotein AI, 29 mg/dL apolipoprotein B,
and 33 mg/dL directly measured low-density lipoprotein cholesterol (LDL-C). Within-study
regression analyses were adjusted for within-person variation and combined using meta-analysis.
The rates of CHD per 1000 person-years in the bottom and top thirds of baseline lipid
distributions, respectively, were 2.6 and 6.2 with triglyceride, 6.4 and 2.4 with
HDL-C, and 2.3 and 6.7 with non-HDL-C. Adjusted HRs for CHD were 0.99 (95% CI, 0.94-1.05)
with triglyceride, 0.78 (95% CI, 0.74-0.82) with HDL-C, and 1.50 (95% CI, 1.39-1.61)
with non-HDL-C. Hazard ratios were at least as strong in participants who did not
fast as in those who did. The HR for CHD was 0.35 (95% CI, 0.30-0.42) with a combination
of 80 mg/dL lower non-HDL-C and 15 mg/dL higher HDL-C. For the subset with apolipoproteins
or directly measured LDL-C, HRs were 1.50 (95% CI, 1.38-1.62) with the ratio non-HDL-C/HDL-C,
1.49 (95% CI, 1.39-1.60) with the ratio apo B/apo AI, 1.42 (95% CI, 1.06-1.91) with
non-HDL-C, and 1.38 (95% CI, 1.09-1.73) with directly measured LDL-C. Hazard ratios
for ischemic stroke were 1.02 (95% CI, 0.94-1.11) with triglyceride, 0.93 (95% CI,
0.84-1.02) with HDL-C, and 1.12 (95% CI, 1.04-1.20) with non-HDL-C.
Lipid assessment in vascular disease can be simplified by measurement of either total
and HDL cholesterol levels or apolipoproteins without the need to fast and without
regard to triglyceride.