Predictive Value of Lipoprotein Indices for Residual Risk of Acute Myocardial Infarction and Sudden Death in Men With Low-Density Lipoprotein Cholesterol Levels <120 mg/dl
Abstract
Several epidemiologic studies have demonstrated that plasma low-density lipoprotein cholesterol (LDL-C) profile is a key risk indicator for coronary heart disease (CHD). However, almost half of all patients with CHD have normal LDL-C levels. A total of 7,931 male subjects aged ≥40 years from the general population with no cardiovascular history and no use of lipid-lowering agents were followed for incidence of acute myocardial infarction (AMI) and sudden death. Of the 4,827 participants with LDL-C levels <120 mg/dl, 55 subjects had a first AMI/sudden death during an average of 5.5 years of follow-up. After adjustment for confounding factors, multiadjusted hazard ratios (HRs) were increased by 1 SD for non-high-density lipoprotein cholesterol (non-HDL-C; HR = 1.36, 95% confidence interval [CI], 1.02 to 1.81), total cholesterol (TC)/HDL-C ratio (HR = 1.40, 95% CI: 1.11 to 1.78) and LDL-C/HDL-C ratio (HR = 1.32, 95% CI: 1.02 to 1.73) but not for LDL-C (HR = 1.09, 95% CI: 0.82 to 1.44) and HDL-C (HR = 0.84, 95% CI: 0.68 to 1.04). When stratified as categorical variables on the basis of points with highest accuracy on receiver operating characteristic analysis, non-HDL-C levels >126 mg/dl (HR = 1.25, 95% CI: 1.03 to 1.51), TC/HDL-C ratio above 3.5 (HR = 1.22, 95% CI: 1.01 to 1.48) and LDL-C/HDL-C ratio >1.9 (HR = 1.25, 95% CI: 1.04 to 1.51) had increased multiadjusted HRs for AMI/sudden death. In conclusion, in men with LDL-C levels <120 mg/dl, non HDL-C, TC/HDL-C, and LDL-C/HDL-C ratios have predictive value for residual risk of AMI/sudden death.
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The risk of CAD and MI onset and death increases when non-HDL-C levels are approximately 140 mg/dL or higher.
“there have been reports stating that the risk of and death from CAD and MI increase when the non-HDL-C levels are approximately ≥ 140 mg/dL67, 71, 72).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [71]
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- Authors
- Tanaka, F., Makita, S., Onoda, T., Tanno, K., Ohsawa, M., Itai, K., Sakata, K., Omama, S.-I., Yoshida, Y., Ogasawara, K., Ogawa, A., Ishibashi, Y., Kuribayashi, T., Okayama, A., & Nakamura, M.
- Affiliations
- Iwate Medical University (JP)
- Iwate University (JP)
- Japan Anti Tuberculosis Association (JP)
- ORCID
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2013-10
- Volume
- 112
- Issue
- 8
- Pages
- 1063-1068
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W1981973358
- Cited by
- 19
- References
- 31
- Citations by year
- 2026: 1 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 2 · 2019: 1 · 2018: 3 · 2017: 2 · 2014: 3 · 2013: 1
- FWCI
- 1.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Takeda Science Foundation
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- non-HDL cholesterol, LDL/HDL ratio, TC/HDL-C ratio, acute myocardial infarction, sudden death, coronary heart disease risk, residual cardiovascular risk, men, risk prediction, HDL cholesterol, triglycerides, risk stratification, receiver operating characteristic, cardiovascular hospitalization
- MeSH terms
- Adult, Aged, Electrocardiography, Follow-Up Studies, Humans, Japan, Cholesterol, LDL, Male, Middle Aged, Myocardial Infarction, Predictive Value of Tests, Prospective Studies, Risk Factors, Biomarkers, Incidence, Survival Rate, Death, Sudden, Cardiac, Risk Assessment
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