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Application of non-HDL cholesterol for population-based cardiovascular risk stratification: results from the Multinational Cardiovascular Risk Consortium

By Fabian J. Brunner, Christoph Waldeyer, Francisco Ojeda, Veikko Salomaa, Frank Kee, Susana Sans, Barbara Thorand, Simona Giampaoli, Paolo Brambilla, Hugh Tunstall-Pedoe, Marie Moitry, Licia Iacoviello, Giovanni Veronesi, Guido Grassi, Ellisiv B. Mathiesen, Stefan Söderberg, Allan Linneberg, Hermann Brenner, Philippe Amouyel, Jean Ferrières, Abdonas Tamosiunas, Yuriy P. Nikitin, Wojciech Drygas, Olle Melander, Karl-Heinz Jöckel, David M. Leistner, Jonathan E. Shaw, Demosthenes B. Panagiotakos, Leon A. Simons, Maryam Kavousi, Ramachandran S. Vasan, Robin P.F. Dullaart, S. Goya Wannamethee, Ulf Risérus, Steven Shea, James A. de Lemos, Torbjørn Omland, Kari Kuulasmaa, Ulf Landmesser and Stefan Blankenberg

Abstract

Background - The relevance of blood lipid concentrations to long-term incidence of cardiovascular disease and the relevance of lipid-lowering therapy for cardiovascular disease outcomes is unclear. We investigated the cardiovascular disease risk associated with the full spectrum of bloodstream non-HDL cholesterol concentrations. We also created an easy-to-use tool to estimate the long-term probabilities for a cardiovascular disease event associated with non-HDL cholesterol and modelled its risk reduction by lipid-lowering treatment. Methods - In this risk-evaluation and risk-modelling study, we used Multinational Cardiovascular Risk Consortium data from 19 countries across Europe, Australia, and North America. Individuals without prevalent cardiovascular disease at baseline and with robust available data on cardiovascular disease outcomes were included. The primary composite endpoint of atherosclerotic cardiovascular disease was defined as the occurrence of the coronary heart disease event or ischaemic stroke. Sex-specific multivariable analyses were computed using non-HDL cholesterol categories according to the European guideline thresholds, adjusted for age, sex, cohort, and classical modifiable cardiovascular risk factors. In a derivation and validation design, we created a tool to estimate the probabilities of a cardiovascular disease event by the age of 75 years, dependent on age, sex, and risk factors, and the associated modelled risk reduction, assuming a 50% reduction of non-HDL cholesterol. Findings - Of the 524 444 individuals in the 44 cohorts in the Consortium database, we identified 398 846 individuals belonging to 38 cohorts (184 055 [48·7%] women; median age 51·0 years [IQR 40·7–59·7]). 199 415 individuals were included in the derivation cohort (91 786 [48·4%] women) and 199 431 (92 269 [49·1%] women) in the validation cohort. During a maximum follow-up of 43·6 years (median 13·5 years, IQR 7·0–20·1), 54 542 cardiovascular endpoints occurred. Incidence curve analyses showed progressively higher 30-year cardiovascular disease event-rates for increasing non-HDL cholesterol categories (from 7·7% for non-HDL cholesterol Interpretation - Non-HDL cholesterol concentrations in blood are strongly associated with long-term risk of atherosclerotic cardiovascular disease. We provide a simple tool for individual long-term risk assessment and the potential benefit of early lipid-lowering intervention. These data could be useful for physician–patient communication about primary prevention strategies

Topics: VDP::Medical disciplines: 700, VDP::Medisinske Fag: 700
Publisher: Elsevier
Year: 2019
DOI identifier: 10.1016/S0140-6736(19)32519-X
OAI identifier: oai:munin.uit.no:10037/17510
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