Beyond Low-Density Lipoprotein Cholesterol
Open accessAbstract
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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Self-citationLanglois, M. R., & Nordestgaard, B. G. (2018) · Current Cardiology Reports · doi:10.1007/s11886-018-1036-1 · Cited by 19 · see citing works
Tanaka, F., Makita, S., Onoda, T., Tanno, K., Ohsawa, M., Itai, K., Sakata, K., Omama, S.-I., Yoshida, Y., Ogasawara, K., et al. (2013) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2013.05.049 · Cited by 19 · see citing works
Comparison of cardiovascular disease risk associated with 3 lipid measures in Japanese adults
Takeuchi, T., Nemoto, K.-I., Takahashi, O., Urayama, K. Y., Deshpande, G. A., & Izumo, H. (2014) · Journal of Clinical Lipidology · doi:10.1016/j.jacl.2014.06.005 · Cited by 12 · see citing works
Kakehi, E., Kotani, K., Ishikawa, S., Gotoh, T., Kayaba, K., Nakamura, Y., & Kajii, E. (2015) · Asia Pacific Journal of Public Health · doi:10.1177/1010539513475649 · Cited by 12 · see citing works
- 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
- ORCID
- 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
- bronze
- doi.org
- Licence
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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