Cited by 342Lipoproteins and Cardiovascular HealthDiabetes, Cardiovascular Risks, and LipoproteinsCholesterol and Lipid Metabolism

Beyond Low-Density Lipoprotein Cholesterol

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Arsenault, Benoit J., Rana, Jamal S., Stroes, Erik S.G., Després, Jean-Pierre, Shah, Prediman K., Kastelein, John J.P., Wareham, Nicholas J., Boekholdt, S. Matthijs +1 more·2009·Journal of the American College of Cardiology

Abstract

Objectives This study was designed to test the hypothesis that at any low-density lipoprotein cholesterol (LDL-C) level, other lipid parameters such as non-high-density lipoprotein cholesterol (HDL-C) levels, triglyceride (TG) levels, and the total cholesterol (TC)/HDL-C are still associated with an increased coronary heart disease (CHD) risk.Background Although LDL-C is considered to be the primary target of lipid-lowering therapy, other parameters of the lipoprotein-lipid profile may more closely associated with CHD risk.Methods In the EPIC (European Prospective Investigation Into Cancer and Nutrition)-Norfolk prospective population study, 21,448 participants without diabetes or CHD between age 45 and 79 years were followed for 11.0 years. A total of 2,086 participants developed CHD during follow-up.Results Among individuals with low LDL-C levels (<100 mg/dl), after adjustment for age, sex, smoking, systolic blood pressure, waist circumference, physical activity, and hormone replacement therapy (in women), those with non-HDL-C >130 mg/dl had a hazard ratio (HR) for future CHD of 1.84 (95% confidence interval [CI]: 1.12 to 3.04) when compared with those with non-HDL-C levels <130 mg/dl. In a similar model, individuals with TG levels >150 mg/dl had an HR of 1.63 (95% CI: 1.02 to 2.59) when compared with those with TG levels <150 mg/dl, and individuals with a TC/HDL-C ratio >5 had an HR of 2.19 (95% CI: 1.22 to 3.93) when compared with those with a TC/HDL-C ratio <5.Conclusions In this prospective study, independently of their plasma LDL-C levels, participants with high non-HDL-C levels, high TG levels, or with an elevated TC/HDL-C ratio were at increased CHD risk. CHD risk assessment algorithms as well as lipid targets of lipid-lowering trials may also need to consider other easily available parameters such as non-HDL-C.

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Crossref · 10.1016/j.jacc.2009.07.057

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Authors
Arsenault, B. J., Rana, J. S., Stroes, E. S. G., Després, J.-P., Shah, P. K., Kastelein, J. J. P., Wareham, N. J., Boekholdt, S. M., & Khaw, K.-T.
Affiliations
  • University of California, Los Angeles (US)
  • Amsterdam UMC Location University of Amsterdam (NL)
  • Institut universitaire de cardiologie et de pneumologie de Québec (CA)
  • University of Cambridge (GB)
Corresponding author
Boekholdt, S. Matthijs
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2009-12
Volume
55
Issue
1
Pages
35-41
ISSN
0735-1097 (ISSN-L)
OpenAlex
W2105595759
Cited by
342
References
74
Citations by year
2026: 15 · 2025: 17 · 2024: 15 · 2023: 12 · 2022: 18 · 2021: 25 · 2020: 22 · 2019: 25 · 2018: 22 · 2017: 18 · 2016: 18 · 2015: 24 · 2014: 17 · 2013: 21 · 2012: 20
FWCI
23.60
Type
journal article
Language
en
Open access
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
  • Cancer Research UK
  • British Heart Foundation
  • European Commission
  • Medical Research Council
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
Keywords
coronary heart disease risk, non-HDL cholesterol, triglycerides, TC/HDL-C ratio, LDL cholesterol, cardiovascular risk assessment, EPIC-Norfolk cohort
MeSH terms
Aged, Coronary Disease, England, Female, Humans, Cholesterol, HDL, Cholesterol, LDL, Male, Middle Aged, Prospective Studies, Risk Factors, Triglycerides

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