Lipid-Related Markers and Cardiovascular Disease Prediction

被引：412

作者：

Di Angelantonio, Emanuele ^{[1
]}

Gao, Pei ^{[1
]}

Pennells, Lisa ^{[1
]}

Kaptoge, Stephen ^{[1
]}

Caslake, Muriel ^{[2
]}

Thompson, Alexander ^{[1
]}

Butterworth, Adam S. ^{[1
]}

Sarwar, Nadeem ^{[1
]}

Wormser, David ^{[1
]}

Saleheen, Danish ^{[1
]}

Ballantyne, Christie M. ^{[3
,4
,5
,6
]}

Psaty, Bruce M.

Sundstrom, Johan ^{[7
]}

Ridker, Paul M. ^{[8
]}

Nagel, Dorothea ^{[9
]}

Gillum, Richard F. ^{[10
]}

Ford, Ian ^{[11
]}

Ducimetiere, Pierre ^{[12
]}

Kiechl, Stefan ^{[13
,14
]}

Dullaart, Robin P. F. ^{[15
]}

Assmann, Gerd

D'Agostino, Ralph B. ^{[16
]}

Dagenais, Gilles R. ^{[17
]}

Cooper, Jackie A. ^{[18
]}

Kromhout, Daan ^{[19
]}

Onat, Altan ^{[20
]}

Tipping, Robert W. ^{[21
]}

Gomez-de-la-Camara, Agustin ^{[22
]}

Rosengren, Annika ^{[23
]}

Sutherland, Susan E. ^{[24
]}

Gallacher, John ^{[25
]}

Fowkes, F. Gerry R. ^{[26
]}

Casiglia, Edoardo ^{[27
]}

Hofman, Albert ^{[28
]}

Salomaa, Veikko ^{[29
]}

Barrett-Connor, Elizabeth ^{[30
]}

Clarke, Robert

Brunner, Eric ^{[31
,32
]}

Jukema, J. Wouter ^{[33
]}

Simons, Leon A. ^{[34
]}

Sandhu, Manjinder

Wareham, Nicholas J. ^{[1
]}

Khaw, Kay-Tee ^{[1
]}

Kauhanen, Jussi ^{[35
]}

Salonen, Jukka T. ^{[36
]}

Howard, William J. ^{[37
]}

Nordestgaard, Borge G. ^{[38
]}

Wood, Angela M.

Thompson, Simon G. ^{[1
]}

Boekholdt, S. Matthijs

机构：

[1] Univ Cambridge, Dept Publ Hlth & Primary Care, Cambridge CB1 8RN, England

[2] Univ Glasgow, Inst Cardiovasc & Med Sci, Glasgow, Lanark, Scotland

[3] Baylor Coll Med, Dept Med, Houston, TX 77030 USA

[4] Univ Washington, Dept Med, Seattle, WA USA

[5] Univ Washington, Dept Epidemiol, Seattle, WA USA

[6] Univ Washington, Dept Hlth Serv, Seattle, WA USA

[7] Uppsala Univ, Uppsala Clin Res Ctr, Uppsala, Sweden

[8] Brigham & Womens Hosp, Div Prevent Med, Boston, MA 02115 USA

[9] LMU, Klinikum Univ Munchen, Munich, Germany

[10] Ctr Dis Control & Prevent, Washington, DC USA

[11] Univ Glasgow, Robertson Ctr Biostat, Glasgow G12 8QQ, Lanark, Scotland

[12] INSERM, F-75654 Paris 13, France

[13] Med Univ Innsbruck, Dept Neurol, Innsbruck, Austria

[14] Univ Ulm, Dept Internal Med Cardiol 2, Med Ctr, Ulm, Germany

[15] Univ Groningen, Univ Groningen Hosp, Univ Med Ctr Groningen, Groningen, Netherlands

[16] Boston Univ, Dept Math & Stat, Boston, MA 02215 USA

[17] Inst Univ Cardiol & Pneumolo Quebec, Dept Med, Quebec City, PQ, Canada

[18] UCL, Ctr Cardiovasc Genet, London WC1E 6BT, England

[19] Wageningen Univ, Div Human Nutr, Wageningen, Netherlands

[20] Istanbul Univ, Inst Expt Med Res, Istanbul, Turkey

[21] Merck Res Labs, Philadelphia, PA USA

[22] Hosp 12 Octubre, Unidad Invest, E-28041 Madrid, Spain

[23] Univ Gothenburg, Dept Med, Sahlgrenska Acad, Gothenburg, Sweden

[24] Med Univ S Carolina, Charleston, SC USA

[25] Cardiff Univ, Dept Epidemiol, Cardiff, S Glam, Wales

[26] Univ Edinburgh, Wolfson Unit, Edinburgh, Midlothian, Scotland

[27] Univ Pavia, Dept Clin & Expt Med, Padua, Italy

[28] Erasmus MC, Dept Epidemiol, Rotterdam, Netherlands

[29] Natl Inst Hlth & Welf, Dept Epidemiol, Helsinki, Finland

[30] Univ Calif San Diego, San Diego, CA 92103 USA

[31] Univ Oxford, Clin Trials Serv Unit, Oxford, England

[32] UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England

[33] Leiden Univ, Dept Cardiol, Med Ctr, Leiden, Netherlands

[34] Univ New S Wales, Lipid Res Dept, Darlinghurst, NSW, Australia

[35] Univ Eastern Finland, Kuopio, Finland

[36] Metab Analyt Serv Inc, Helsinki, Finland

[37] Washington Hosp Ctr, Hlth Res Inst, Washington, DC 20010 USA

[38] Univ Copenhagen, Dept Clin Biochem, Copenhagen, Denmark

[39] Univ Amsterdam, Acad Med Ctr, NL-1105 AZ Amsterdam, Netherlands

[40] Univ Glasgow, Inst Cardiovasc & Med Sci, Glasgow G12 8QQ, Lanark, Scotland

来源：

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2012年 / 307卷 / 23期

基金：

英国医学研究理事会; 欧洲研究理事会; 瑞典研究理事会; 美国国家卫生研究院; 英国惠康基金;

关键词：

NON-HDL CHOLESTEROL; APOLIPOPROTEIN-B; MYOCARDIAL-INFARCTION; LDL CHOLESTEROL; A-I; RISK; LIPOPROTEINS; GUIDELINES; METAANALYSIS; ASSOCIATION;

D O I：

10.1001/jama.2012.6571

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Context The value of assessing various emerging lipid-related markers for prediction of first cardiovascular events is debated. Objective To determine whether adding information on apolipoprotein B and apolipoprotein A-I, lipoprotein(a), or lipoprotein-associated phospholipase A(2) to total cholesterol and high-density lipoprotein cholesterol (HDL-C) improves cardiovascular disease (CVD) risk prediction. Design, Setting, and Participants Individual records were available for 165 544 participants without baseline CVD in 37 prospective cohorts (calendar years of recruitment: 1968-2007) with up to 15 126 incident fatal or nonfatal CVD outcomes (10 132 CHD and 4994 stroke outcomes) during a median follow-up of 10.4 years (interquartile range, 7.6-14 years). Main Outcome Measures Discrimination of CVD outcomes and reclassification of participants across predicted 10-year risk categories of low (<10%), intermediate (10%-<20%), and high (>= 20%) risk. Results The addition of information on various lipid-related markers to total cholesterol, HDL-C, and other conventional risk factors yielded improvement in the model's discrimination: C-index change, 0.0006 (95% CI, 0.0002-0.0009) for the combination of apolipoprotein B and A-I; 0.0016 (95% CI, 0.0009-0.0023) for lipoprotein(a); and 0.0018 (95% CI, 0.0010-0.0026) for lipoprotein-associated phospholipase A(2) mass. Net reclassification improvements were less than 1% with the addition of each of these markers to risk scores containing conventional risk factors. We estimated that for 100 000 adults aged 40 years or older, 15 436 would be initially classified at intermediate risk using conventional risk factors alone. Additional testing with a combination of apolipoprotein B and A-I would reclassify 1.1%; lipoprotein(a), 4.1%; and lipoprotein-associated phospholipase A(2) mass, 2.7% of people to a 20% or higher predicted CVD risk category and, therefore, in need of statin treatment under Adult Treatment Panel III guidelines. Conclusion In a study of individuals without known CVD, the addition of information on the combination of apolipoprotein B and A-I, lipoprotein(a), or lipoprotein-associated phospholipase A(2) mass to risk scores containing total cholesterol and HDL-C led to slight improvement in CVD prediction. JAMA. 2012; 307(23):2499-2506 www.jama.com

引用

页码：2499 / 2506

页数：8

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