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Risk Factors for Cardiovascular Disease in Women

Non-HDL Cholesterol, Apolipoproteins A-I and B100, Standard Lipid Measures, Lipid Ratios, and CRP as Risk Factors for Cardiovascular Disease in Women

Paul M Ridker, MD; et al JAMA. 2005;294:326-333.

Current guidelines for cardiovascular risk detection are controversial with regard to the clinical utility of different lipid measures, non-high-density lipoprotein cholesterol (non-HDL-C), lipid ratios, apolipoproteins, and C-reactive protein (CRP).

Objective  To directly compare the clinical utility of total cholesterol, low-density lipoprotein cholesterol (LDL-C), HDL-C, non-HDL-C, apolipoproteins A-I and B100, high-sensitivity CRP, and the ratios of total cholesterol to HDL-C, LDL-C to HDL-C, apolipoprotein B100 to apolipoprotein A-I, and apolipoprotein B100 to HDL-C as predictors of future cardiovascular events in women.

Prospective cohort study of 15 632 initially healthy US women aged 45 years or older who were enrolled between November 1992 and July 1995. All participants were followed up over a 10-year period for the occurrence of future cardiovascular events.

Results  After adjustment for age, smoking status, blood pressure, diabetes, and body mass index, the HRs for future cardiovascular events for those in the extreme quintiles were 1.62 for LDL-C, 1.75 for apolipoprotein A-I, 2.08  for total cholesterol, 2.32 for HDL-C, 2.5 for apolipoprotein B100, 2.51 for non-HDL-C, and 2.98 for high-sensitivity CRP.

Conclusions  Non-HDL-C and the ratio of total cholesterol to HDL-C were as good as or better than apolipoprotein fractions in the prediction of future cardiovascular events. After adjustment for age, blood pressure, smoking, diabetes, and obesity, high-sensitivity CRP added prognostic information beyond that conveyed by all lipid measures.

Comment: In terms of lipid measurements, none of the values tested were as useful as Total Chol and HDL. CRP is an independent risk factor. GLE

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