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Prediction of future development of cardiovascular disease with an equation to estimate apolipoprotein B

View Article: PubMed Central - PubMed

ABSTRACT

Apolipoprotein B (apoB) has additional benefits over conventional lipid measurements in predicting future cardiovascular disease (CVD). We aimed to validate the clinical relevance of our equation to estimate apoB in a large-scale, prospective, community-based cohort study (Ansung-Ansan cohort study).

A total of 9001 Korean subjects were assessed. We excluded subjects with history of CVD (n = 228), taking lipid-lowering medications (n = 51), and those whose outcome data were not available (n = 33). Finally, a total of 8713 subjects (4126 men and 4587 women) with a mean age of 52.2 years were enrolled and followed up biannually for a mean 8.1 years.

At baseline, 24.9% of subjects were current smokers, 12.5% had diabetes, and 22.2% had hypertension. Incident case of CVD occurred in 600 of the study subjects (493 ischemic heart disease and 424 stroke). Independent variables included in the models were age, sex, waist circumference, current smoking, and presence of diabetes and hypertension. Both non-HDL cholesterol (HR per 1-SD [95% CI]; 1.13 [1.05–1.23], P = 0.002) and estimated apoB (HR per 1-SD [95% CI]; 1.14 [1.05–1.24], P = 0.001) were independently associated with the development of CVD; however, the LDL cholesterol level was not predictive of future CVD (HR per 1-SD [95% CI]; 1.07 [0.99–1.16], P = 0.08).

Both non-HDL cholesterol and estimated apoB level were independently associated with the development of CVD. Because LDL cholesterol has limited value to predict incident CVD, we recommend calculating non-HDL cholesterol or apoB with our equation to predict risk of incident CVD in the general Korean population.

No MeSH data available.


Related in: MedlinePlus

Kaplan–Meier survival curve for development of cardiovascular disease according to median estimated apoB (A, P < 0.001) and LDL cholesterol (B, P = 0.017) levels. Black and gray lines represent the upper and lower median for corresponding variables, respectively. LDL = low-density lipoprotein.
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Figure 1: Kaplan–Meier survival curve for development of cardiovascular disease according to median estimated apoB (A, P < 0.001) and LDL cholesterol (B, P = 0.017) levels. Black and gray lines represent the upper and lower median for corresponding variables, respectively. LDL = low-density lipoprotein.

Mentions: Incident CVD occurred in 600 of the study subjects (493 IHD and 424 stroke) during the mean 8.1-year follow-up, leading to a cumulative incidence of 6.9%. In univariate Cox proportional hazard regression analysis, a variety of conventional risk factors, including age, BMI, waist circumference, blood pressures, HOMA-IR, and presence of diabetes and hypertension, were associated with the development of CVD. Among all lipid measurements, non-HDL cholesterol (HR per 1-SD increment [95% CI]; 1.24 [1.15–1.34], P < 0.001) and estimated apoB (HR per 1-SD increment [95% CI]; 1.24 [1.15–1.34], P < 0.001) levels showed the strongest associations with the development of CVD, and their HRs were identical. However, the LDL cholesterol level showed a somewhat weaker association with the development of CVD compared with non-HDL cholesterol or estimated apoB level (HR per 1-SD increment [95% CI]; 1.11 [1.03–1.12], P = 0.008) (Table 2). In addition, when the subjects were divided into 2 groups according to median levels, estimated apoB was discriminative earlier than LDL cholesterol for the development of incident CVD (Fig. 1). Similarly, in a separate analysis, non-HDL cholesterol and estimated apoB levels were more powerful predictors of future IHD and stroke than was the LDL cholesterol level.


Prediction of future development of cardiovascular disease with an equation to estimate apolipoprotein B
Kaplan–Meier survival curve for development of cardiovascular disease according to median estimated apoB (A, P < 0.001) and LDL cholesterol (B, P = 0.017) levels. Black and gray lines represent the upper and lower median for corresponding variables, respectively. LDL = low-density lipoprotein.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998433&req=5

Figure 1: Kaplan–Meier survival curve for development of cardiovascular disease according to median estimated apoB (A, P < 0.001) and LDL cholesterol (B, P = 0.017) levels. Black and gray lines represent the upper and lower median for corresponding variables, respectively. LDL = low-density lipoprotein.
Mentions: Incident CVD occurred in 600 of the study subjects (493 IHD and 424 stroke) during the mean 8.1-year follow-up, leading to a cumulative incidence of 6.9%. In univariate Cox proportional hazard regression analysis, a variety of conventional risk factors, including age, BMI, waist circumference, blood pressures, HOMA-IR, and presence of diabetes and hypertension, were associated with the development of CVD. Among all lipid measurements, non-HDL cholesterol (HR per 1-SD increment [95% CI]; 1.24 [1.15–1.34], P < 0.001) and estimated apoB (HR per 1-SD increment [95% CI]; 1.24 [1.15–1.34], P < 0.001) levels showed the strongest associations with the development of CVD, and their HRs were identical. However, the LDL cholesterol level showed a somewhat weaker association with the development of CVD compared with non-HDL cholesterol or estimated apoB level (HR per 1-SD increment [95% CI]; 1.11 [1.03–1.12], P = 0.008) (Table 2). In addition, when the subjects were divided into 2 groups according to median levels, estimated apoB was discriminative earlier than LDL cholesterol for the development of incident CVD (Fig. 1). Similarly, in a separate analysis, non-HDL cholesterol and estimated apoB levels were more powerful predictors of future IHD and stroke than was the LDL cholesterol level.

View Article: PubMed Central - PubMed

ABSTRACT

Apolipoprotein B (apoB) has additional benefits over conventional lipid measurements in predicting future cardiovascular disease (CVD). We aimed to validate the clinical relevance of our equation to estimate apoB in a large-scale, prospective, community-based cohort study (Ansung-Ansan cohort study).

A total of 9001 Korean subjects were assessed. We excluded subjects with history of CVD (n = 228), taking lipid-lowering medications (n = 51), and those whose outcome data were not available (n = 33). Finally, a total of 8713 subjects (4126 men and 4587 women) with a mean age of 52.2 years were enrolled and followed up biannually for a mean 8.1 years.

At baseline, 24.9% of subjects were current smokers, 12.5% had diabetes, and 22.2% had hypertension. Incident case of CVD occurred in 600 of the study subjects (493 ischemic heart disease and 424 stroke). Independent variables included in the models were age, sex, waist circumference, current smoking, and presence of diabetes and hypertension. Both non-HDL cholesterol (HR per 1-SD [95% CI]; 1.13 [1.05&ndash;1.23], P = 0.002) and estimated apoB (HR per 1-SD [95% CI]; 1.14 [1.05&ndash;1.24], P = 0.001) were independently associated with the development of CVD; however, the LDL cholesterol level was not predictive of future CVD (HR per 1-SD [95% CI]; 1.07 [0.99&ndash;1.16], P = 0.08).

Both non-HDL cholesterol and estimated apoB level were independently associated with the development of CVD. Because LDL cholesterol has limited value to predict incident CVD, we recommend calculating non-HDL cholesterol or apoB with our equation to predict risk of incident CVD in the general Korean population.

No MeSH data available.


Related in: MedlinePlus