Lipid-Related Markers and Cardiovascular Disease Prediction

E Di Angelantonio, P Gao, L Pennells, S Kaptoge, M Caslake, A Thompson, AS Butterworth, N Sarwar, D Wormser, D Saleheen, CM Ballantyne, BM Psaty, J Sundstrom, PM Ridker, D Nagel, RF Gillum, I Ford, P Ducimetiere, S Kiechl, RPF DullaartG Assmann, RB D'Agostino, GR Dagenais, JA Cooper, D Kromhout, A Onat, RW Tipping, A Gomez-de-la-Camara, A Rosengren, SE Sutherland, J Gallacher, FGR Fowkes, E Casiglia, Bert Hofman, V Salomaa, E Barrett-Connor, R Clarke, E Brunner, JW Jukema, LA Simons, M Sandhu, NJ Wareham, KT Khaw, J Kauhanen, JT Salonen, WJ Howard, BG Nordestgaard, AM Wood, SG Thompson, SM Boekholdt, N Sattar, C Packard, V Gudnason, J Danesh

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Context The value of assessing various emerging lipid-related markers for prediction of first cardiovascular events is debated. Objective To determine whether adding information on apolipoprotein B and apolipoprotein A-I, lipoprotein(a), or lipoprotein-associated phospholipase A(2) to total cholesterol and high-density lipoprotein cholesterol (HDL-C) improves cardiovascular disease (CVD) risk prediction. Design, Setting, and Participants 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). Main Outcome Measures Discrimination of CVD outcomes and reclassification of participants across predicted 10-year risk categories of low (<10%), intermediate (10%-<20%), and high (>= 20%) risk. Results 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 A(2) mass. Net reclassification improvements were less than 1% with the addition of each of Conclusion 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 A(2) mass to risk scores containing total cholesterol and HDL-C led to slight improvement in CVD prediction. JAMA. 2012; 307(23):2499-2506
Original languageUndefined/Unknown
Pages (from-to)2499-2506
Number of pages8
JournalJAMA - Journal of the American Medical Association
Issue number23
Publication statusPublished - 2012

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  • EMC NIHES-01-64-01

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