A comparison of lipid variables as predictors of cardiovascular disease in the Asia Pacific region.
OBJECTIVE
Many guidelines advocate measurement of total or low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), and triglycerides (TG) to determine treatment recommendations for preventing coronary heart disease (CHD) and cardiovascular disease (CVD). This analysis is a comparison of lipid variables as predictors of cardiovascular disease.


METHODS
Hazard ratios for coronary and cardiovascular deaths by fourths of total cholesterol (TC), LDL, HDL, TG, non-HDL, TC/HDL, and TG/HDL values, and for a one standard deviation change in these variables, were derived in an individual participant data meta-analysis of 32 cohort studies conducted in the Asia-Pacific region. The predictive value of each lipid variable was assessed using the likelihood ratio statistic.


RESULTS
Adjusting for confounders and regression dilution, each lipid variable had a positive (negative for HDL) log-linear association with fatal CHD and CVD. Individuals in the highest fourth of each lipid variable had approximately twice the risk of CHD compared with those with lowest levels. TG and HDL were each better predictors of CHD and CVD risk compared with TC alone, with test statistics similar to TC/HDL and TG/HDL ratios. Calculated LDL was a relatively poor predictor.


CONCLUSIONS
While LDL reduction remains the main target of intervention for lipid-lowering, these data support the potential use of TG or lipid ratios for CHD risk prediction.
Barzi
F
F
The George Institute for International Health, University of Sydney, Camperdown, NSW 2050, Australia. fbarzi@thegeorgeinstitute.org
Patel
A
A
Woodward
M
M
Lawes
C M M
CM
Ohkubo
T
T
Gu
D
D
Lam
T H
TH
Ueshima
H
H
D000328:Adult; D000368:Aged; D001210:Asia, Southeastern / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000097:blood* / Q000453:epidemiology / Q000401:mortality; D002784:Cholesterol / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011237:Predictive Value of Tests; D014280:Triglycerides / Q000097:blood*
D014280:Triglycerides; D002784:Cholesterol