VLDL Cholesterol Accounts for One-Half of the Risk of Myocardial Infarction Associated With apoB-Containing Lipoproteins
Open accessAbstract
Background Plasma apolipoprotein B (apoB) is a composite measure of all apoB-containing lipoproteins causing atherosclerotic cardiovascular disease; however, it is unclear which fraction of risk is explained by cholesterol and triglycerides, respectively, in very low-density lipoproteins (VLDLs). Objectives The authors tested the hypothesis that VLDL cholesterol and triglycerides each explain part of the myocardial infarction risk from apoB-containing lipoproteins. Methods Nested within 109,751 individuals from the Copenhagen General Population Study, the authors examined 25,480 subjects free of lipid-lowering therapy and myocardial infarction at study entry. All had measurements of plasma apoB (quantitating number of apoB-containing lipoproteins) and cholesterol and triglyceride content of VLDL, intermediate-density lipoproteins (IDLs), and low-density lipoproteins (LDLs). Results During a median 11 years of follow-up, 1,816 were diagnosed with myocardial infarction. Per 1-mmol/l higher levels, multivariable-adjusted hazard ratios for myocardial infarction were 2.07 (95% confidence interval [CI]: 1.81 to 2.36) for VLDL cholesterol, 1.19 (95% CI: 1.14 to 1.25) for VLDL triglycerides, 5.38 (95% CI: 3.73 to 7.75) for IDL cholesterol, and 1.86 (95% CI: 1.62 to 2.14) for LDL cholesterol. Per 1-g/l higher plasma apoB, the corresponding value was 2.21 (95% CI: 1.90 to 2.58). In a step-up Cox regression, risk factors for myocardial infarction entered by importance as VLDL cholesterol, systolic blood pressure, smoking, and IDL + LDL cholesterol, whereas VLDL triglycerides did not enter the model. VLDL cholesterol explained 50% and IDL + LDL cholesterol 29% of the risk of myocardial infarction from apoB-containing lipoproteins, whereas VLDL triglycerides did not explain risk. Conclusions VLDL cholesterol explained one-half of the myocardial infarction risk from elevated apoB-containing lipoproteins, whereas VLDL triglycerides did not explain risk.
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Recent studies have suggested that triglycerides and remnant cholesterol may be more potent risk factors for myocardial infarction than LDL-C is.
“These studies have suggested that TG and remnant cholesterol may be more potent risk factors for myocardial infarction (MI) than LDL-C is.2,3”
From Association of Apolipoprotein B–Containing Lipoproteins and Risk of Myocardial Infarction in Individuals With and Without Atherosclerosis (2022) · cites this paper as [3]
The paper’s Abstract (page unavailable) reports that VLDL cholesterol explained 50% of the myocardial-infarction risk associated with apoB-containing lipoproteins, compared with 29% for IDL plus LDL cholesterol. This supports the remnant-cholesterol portion of the claim. It does not support the triglyceride portion: the same passage says VLDL triglycerides did not explain that risk. (LLM, conf=0.88)
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- Authors
- Balling, M., Afzal, S., Varbo, A., Langsted, A., Davey Smith, G., & Nordestgaard, B. G.
- Affiliations
- University of Copenhagen (DK)
- Corresponding author
- Nordestgaard, Børge G.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2020-12
- Volume
- 76
- Issue
- 23
- Pages
- 2725-2735
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W3107369671
- Cited by
- 175
- References
- 61
- Citations by year
- 2026: 12 · 2025: 25 · 2024: 39 · 2023: 35 · 2022: 24 · 2021: 39 · 2020: 1
- FWCI
- 22.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
- Funders
- University of Bristol (MC_UU_00011/1)
- Novo Nordisk Fonden (NNF18OC0052893)
- Hjerteforeningen (18-R124-A8511-22089)
- 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 › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Keywords
- apolipoprotein B, apoB-containing lipoproteins, VLDL cholesterol, VLDL triglycerides, intermediate-density lipoprotein cholesterol, LDL cholesterol, myocardial infarction risk, atherosclerotic cardiovascular disease, lipoprotein fractions, Copenhagen General Population Study, smoking, systolic blood pressure
- MeSH terms
- Aged, Apolipoproteins B, Denmark, Female, Humans, Lipoproteins, VLDL, Male, Middle Aged, Myocardial Infarction, Risk, Triglycerides, Cholesterol, VLDL, Cohort Studies
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