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Lipid-related markers and cardiovascular disease prediction.
Tuesday,2012-11-06 12:26 America/Los_Angeles — eenright
| Title | Lipid-related markers and cardiovascular disease prediction. |
| Publication Type | Journal Article |
| Year of Publication | 2012 |
| Authors | Di Angelantonio, E, Gao, P, Pennells, L, Kaptoge, S, Caslake, M, Thompson, A, Butterworth, AS, Sarwar, N, Wormser, D, Saleheen, D, Ballantyne, CM, Psaty, BM, Sundström, J, Ridker, PM, Nagel, D, Gillum, RF, Ford, I, Ducimetiere, P, Kiechl, S, Koenig, W, Dullaart, RPF, Assmann, G, D'Agostino, RB, Dagenais, GR, Cooper, JA, Kromhout, D, Onat, A, Tipping, RW, Gómez-de-la-Cámara, A, Rosengren, A, Sutherland, SE, Gallacher, J, F Fowkes, GR, Casiglia, E, Hofman, A, Salomaa, V, Barrett-Connor, E, Clarke, R, Brunner, E, J Jukema, W, Simons, LA, Sandhu, M, Wareham, NJ, Khaw, K-T, Kauhanen, J, Salonen, JT, Howard, WJ, Nordestgaard, BG, Wood, AM, Thompson, SG, S Boekholdt, M, Sattar, N, Packard, C, Gudnason, V, Danesh, J |
| Corporate/Institutional Authors | Emerging Risk Factors Collaboration, |
| Journal | JAMA |
| Volume | 307 |
| Issue | 23 |
| Pagination | 2499-506 |
| Date Published | 2012 Jun 20 |
| ISSN | 1538-3598 |
| Keywords | Aged, Biomarkers, Cardiovascular Diseases, Cholesterol, HDL, Cohort Studies, Female, Humans, Lipoproteins, Male, Middle Aged, Risk Assessment |
| Abstract | <p><b>CONTEXT: </b>The value of assessing various emerging lipid-related markers for prediction of first cardiovascular events is debated.</p><p><b>OBJECTIVE: </b>To determine whether adding information on apolipoprotein B and apolipoprotein A-I, lipoprotein(a), or lipoprotein-associated phospholipase A2 to total cholesterol and high-density lipoprotein cholesterol (HDL-C) improves cardiovascular disease (CVD) risk prediction.</p><p><b>DESIGN, SETTING, AND PARTICIPANTS: </b>Individual records were available for 165,544 participants without baseline CVD in 37 prospective cohorts (calendar years of recruitment: 1968-2007) with up to 15,126 incident fatal or nonfatal CVD outcomes (10,132 CHD and 4994 stroke outcomes) during a median follow-up of 10.4 years (interquartile range, 7.6-14 years).</p><p><b>MAIN OUTCOME MEASURES: </b>Discrimination of CVD outcomes and reclassification of participants across predicted 10-year risk categories of low (<10%), intermediate (10%-<20%), and high (≥20%) risk.</p><p><b>RESULTS: </b>The addition of information on various lipid-related markers to total cholesterol, HDL-C, and other conventional risk factors yielded improvement in the model's discrimination: C-index change, 0.0006 (95% CI, 0.0002-0.0009) for the combination of apolipoprotein B and A-I; 0.0016 (95% CI, 0.0009-0.0023) for lipoprotein(a); and 0.0018 (95% CI, 0.0010-0.0026) for lipoprotein-associated phospholipase A2 mass. Net reclassification improvements were less than 1% with the addition of each of these markers to risk scores containing conventional risk factors. We estimated that for 100,000 adults aged 40 years or older, 15,436 would be initially classified at intermediate risk using conventional risk factors alone. Additional testing with a combination of apolipoprotein B and A-I would reclassify 1.1%; lipoprotein(a), 4.1%; and lipoprotein-associated phospholipase A2 mass, 2.7% of people to a 20% or higher predicted CVD risk category and, therefore, in need of statin treatment under Adult Treatment Panel III guidelines.</p><p><b>CONCLUSION: </b>In a study of individuals without known CVD, the addition of information on the combination of apolipoprotein B and A-I, lipoprotein(a), or lipoprotein-associated phospholipase A2 mass to risk scores containing total cholesterol and HDL-C led to slight improvement in CVD prediction.</p> |
| DOI | 10.1001/jama.2012.6571 |
| Alternate Journal | JAMA |
| PubMed ID | 22797450 |
| PubMed Central ID | PMC4211641 |
| Grant List | G0601284 / / Medical Research Council / United Kingdom / / British Heart Foundation / United Kingdom G19/35 / / Medical Research Council / United Kingdom U01 HL080295 / HL / NHLBI NIH HHS / United States G0100222 / / Medical Research Council / United Kingdom HHSN268200800007C / HL / NHLBI NIH HHS / United States RG/08/014/24067 / / British Heart Foundation / United Kingdom G0501792 / / Medical Research Council / United Kingdom / / Medical Research Council / United Kingdom G8802774 / / Medical Research Council / United Kingdom G1000143 / / Medical Research Council / United Kingdom RG/08/013/25942 / / British Heart Foundation / United Kingdom G0902037 / / Medical Research Council / United Kingdom N01HC55222 / HL / NHLBI NIH HHS / United States MC_U137686857 / / Medical Research Council / United Kingdom N01HC85086 / HL / NHLBI NIH HHS / United States MC_U106179471 / / Medical Research Council / United Kingdom UL1 TR000062 / TR / NCATS NIH HHS / United States G0401527 / / Medical Research Council / United Kingdom G0701863 / / Medical Research Council / United Kingdom G0701619 / / Medical Research Council / United Kingdom N01HC85082 / HL / NHLBI NIH HHS / United States N01HC85083 / HL / NHLBI NIH HHS / United States MC_U105260792 / / Medical Research Council / United Kingdom N01HC85079 / HL / NHLBI NIH HHS / United States R01 AG023629 / AG / NIA NIH HHS / United States N01HC85080 / HL / NHLBI NIH HHS / United States N01HC85081 / HL / NHLBI NIH HHS / United States RG/07/008/23674 / / British Heart Foundation / United Kingdom |