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Cited by 744Lipoproteins and Cardiovascular HealthDiabetes, Cardiovascular Risks, and LipoproteinsHealth Promotion and Cardiovascular Prevention

Non–HDL Cholesterol, Apolipoproteins A-I and B 100 , Standard Lipid Measures, Lipid Ratios, and CRP as Risk Factors for Cardiovascular Disease in Women

Ridker, Paul M, Rifai, Nader, Cook, Nancy R., Bradwin, Gary, Buring, Julie E.·2005·JAMA
DOI 10.1001/jama.294.3.326
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Abstract

CONTEXT: 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 B(100), high-sensitivity CRP, and the ratios of total cholesterol to HDL-C, LDL-C to HDL-C, apolipoprotein B(100) to apolipoprotein A-I, and apolipoprotein B(100) to HDL-C as predictors of future cardiovascular events in women. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of 15,632 initially healthy US women aged 45 years or older (interquartile range, 48-59 years) 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. MAIN OUTCOME MEASURE: Hazard ratios (HRs) and 95% confidence intervals (CIs) for first-ever major cardiovascular events (N = 464) according to baseline levels of each biomarker. 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 (95% CI, 1.17-2.25) for LDL-C, 1.75 (95% CI, 1.30-2.38) for apolipoprotein A-I, 2.08 (95% CI, 1.45-2.97) for total cholesterol, 2.32 (95% CI, 1.64-3.33) for HDL-C, 2.50 (95% CI, 1.68-3.72) for apolipoprotein B(100), 2.51 (95% CI, 1.69-3.72) for non-HDL-C, and 2.98 (95% CI, 1.90-4.67) for high-sensitivity CRP (P<.001 for trend across all quintiles). The HRs for the lipid ratios were 3.01 (95% CI, 2.01-4.50) for apolipoprotein B(100) to apolipoprotein A-I, 3.18 (95% CI, 2.12-4.75) for LDL-C to HDL-C, 3.56 (95% CI, 2.31-5.47) for apolipoprotein B(100) to HDL-C, and 3.81 (95% CI, 2.47-5.86) for the total cholesterol to HDL-C (P<.001 for trend across all quintiles). The correlation coefficients between high-sensitivity CRP and the lipid parameters ranged from -0.33 to 0.15, and the clinical cut points for CRP of less than 1, 1 to 3, and higher than 3 mg/L provided prognostic information on risk across increasing levels of each lipid measure and lipid ratio. 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.

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Authors
Ridker, P. M., Rifai, N., Cook, N. R., Bradwin, G., & Buring, J. E.
Affiliations
Brigham and Women's Hospital (US)
Corresponding author
Ridker, Paul M
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2005-07-20
Volume
294
Issue
3
Pages
326
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.294.3.326
OpenAlex
W2040433877
Cited by
744
References
40
Citations by year
2026: 18 · 2025: 10 · 2024: 18 · 2023: 17 · 2022: 26 · 2021: 18 · 2020: 36 · 2019: 24 · 2018: 30 · 2017: 24 · 2016: 25 · 2015: 36 · 2014: 34 · 2013: 40 · 2012: 45
FWCI
55.16
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
Keywords
non-HDL cholesterol, apolipoprotein A-I, apolipoprotein B-100, C-reactive protein, lipid ratios, cardiovascular risk factors, postmenopausal women, LDL cholesterol, HDL cholesterol, total cholesterol, apolipoprotein B/A-I ratio, cardiovascular risk prediction, coronary artery disease
MeSH terms
Apolipoproteins, C-Reactive Protein, Cardiovascular Diseases, Cholesterol, Female, Humans, Lipoproteins, Middle Aged, Prospective Studies, Risk Factors, Biomarkers, Proportional Hazards Models

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