title: Oxidized LDL and the risk of coronary heart disease: results from the MONICA/KORA Augsburg Study.
abstract: BACKGROUND
  Oxidative stress plays a critical role in the initiation and progression of atherosclerosis. Oxidized LDL (oxLDL) is a marker of oxidative stress. We prospectively investigated whether increased serum oxLDL concentrations are associated with incident coronary heart disease (CHD).
  
  
  METHODS
  We conducted a prospective population-based case-cohort study within the MONICA/KORA Augsburg studies. Serum oxLDL concentrations were measured in 333 case individuals with incident CHD and in 1727 noncase individuals selected from a source population of 9300 middle-aged, healthy men and women. The mean (SD) follow-up time was 10.8 (4.6) years.
  
  
  RESULTS
  Baseline oxLDL concentrations were higher in case individuals than in noncase individuals (P < 0.001). After adjustment for age, sex, survey, smoking status, systolic blood pressure, physical activity, diabetes, body mass index, parental history of myocardial infarction, and alcohol consumption, the hazard ratio (HR) for comparing the first and third tertiles was 1.87 (95% CI, 1.33-2.64; P < 0.001). Additional adjustment for lipid parameters, inflammatory markers, and markers of endothelial dysfunction attenuated the association (HR, 1.29; 95% CI, 0.88-1.89; P = 0.087). We observed no significant interactions between oxLDL and sex or being overweight.
  
  
  CONCLUSIONS
  Increased oxLDL concentrations were associated with an increased risk for incident CHD. Nevertheless, because this effect became nonsignificant after adjustment for covariates, particularly the ratio of total cholesterol to HDL cholesterol, it may be mediated primarily by lipid parameters. Further studies are warranted to clarify this issue.
authors.affiliation: Department of Internal Medicine II - Cardiology, University of Ulm Medical Center, Ulm, Germany. koenig@uniklinik-ulm.de
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Koenig
authors.forename: Mahir
authors.initials: M
authors.lastname: Karakas
authors.forename: Astrid
authors.initials: A
authors.lastname: Zierer
authors.forename: Christian
authors.initials: C
authors.lastname: Herder
authors.forename: Jens
authors.initials: J
authors.lastname: Baumert
authors.forename: Christa
authors.initials: C
authors.lastname: Meisinger
authors.forename: Barbara
authors.initials: B
authors.lastname: Thorand
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D003327:Coronary Disease / Q000453:epidemiology*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D005260:Female; D006801:Humans; D008077:Lipoproteins, LDL / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D011446:Prospective Studies; D018570:Risk Assessment; D055815:Young Adult
chemical_list: D015415:Biomarkers; D008077:Lipoproteins, LDL; C099252:oxidized low density lipoprotein