Lipid-Related Markers and Cardiovascular Disease Prediction

Study Questions:

What lipid-related markers should be used to assess risk for cardiovascular disease (CVD)?

Methods:

A total of 165,544 participants without baseline CVD in 37 prospective cohorts were followed for a median of 10 years. There were 15,126 fatal or nonfatal CVD events (10,132 CHD and 4,994 stroke outcomes). The main outcome measure was 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, high-density lipoprotein cholesterol (HDL-C), and other conventional risk factors yielded improvement in the model’s discrimination: C-index change, 0.0006 for the combination of apolipoprotein (apo) B and A-I; 0.0016 for lipoprotein(a); and 0.0018 for lipoprotein-associated phospholipase A2 mass. Net reclassification improvements were <1% with the addition of each of these markers to risk scores containing conventional risk factors.

Conclusions:

The authors concluded that the additional information provided by the combination of apoB and A-I, lipoprotein(a), or lipoprotein-associated phospholipase A2 mass to risk scores containing total cholesterol, and HDL-C led to a slight improvement in CVD prediction in patients without previously diagnosed CVD.

Perspective:

The lipid data needed to assess risk for primary CVD prevention are controversial. In this study, replacing total cholesterol and HDL-C with apoB and apoA1 did not improve CV risk prediction, and addition of these and other lipid-related markers to total cholesterol and HDL-C added only modestly to risk prediction. The clinical utility of these additional lipid-related factors in guiding patient management is not clear and remains to be established.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Lipid Metabolism, Nonstatins

Keywords: Stroke, Biological Markers, Apolipoprotein A-I, Cardiovascular Diseases, Cholesterol, HDL


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