title: Impact of diabetes, high triglycerides and low HDL cholesterol on risk for ischemic cardiovascular disease varies by LDL cholesterol level: a 15-year follow-up of the Chinese Multi-provincial Cohort Study.
abstract: OBJECTIVE
  A large proportion of ischemic cardiovascular disease occur in people without hypercholesterolemia. We aimed to investigate whether risk factors other than low-density lipoprotein cholesterol (LDL-C) have different impacts on cardiovascular risk in people with low verses high LDL-C levels.
  
  
  METHODS
  A total of 30,378 participants (35-64 years) were followed for 15 years in the Chinese Multi-provincial Cohort Study. Associations of coronary heart disease (CHD) and ischemic stroke with risk factors other than LDL-C were assessed in participants with low (<130 mg/dL) and high (≥130 mg/dL) LDL-C levels.
  
  
  RESULTS
  During the follow-up, 65.5% of CHD and 70.2% of ischemic stroke events occurred in participants with low LDL-C. High triglycerides predicted CHD (HR=1.74, 95% CI 1.25-2.42, P=0.001), and low HDL-C predicted ischemic stroke (HR=1.54, 95% CI 1.18-2.03, P=0.002) only in participants with low LDL-C. Diabetes predicted CHD in participants with high LDL-C (HR=2.38, 95% CI 1.31-4.34, P=0.005), but not in those with low LDL-C. Older age, male, hypertension, central obesity, and smoking had similar effects on the risk in both groups.
  
  
  CONCLUSIONS
  Triglycerides and low HDL-C should be addressed in the management of dyslipidemia in people with low LDL-C. When LDL-C is high, tighter management of glycemia and LDL-C is warranted.
authors.affiliation: Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: Miao
authors.initials: M
authors.lastname: Wang
authors.forename: Jiayi
authors.initials: J
authors.lastname: Sun
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.forename: Yue
authors.initials: Y
authors.lastname: Qi
authors.forename: Zhaosu
authors.initials: Z
authors.lastname: Wu
authors.forename: Dong
authors.initials: D
authors.lastname: Zhao
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000097:blood* / Q000453:epidemiology / Q000209:etiology*; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000097:blood*; D050171:Dyslipidemias / Q000097:blood / Q000151:congenital / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D014280:Triglycerides / Q000097:blood*
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D014280:Triglycerides