title: Predictive value of lipoprotein indices for residual risk of acute myocardial infarction and sudden death in men with low-density lipoprotein cholesterol levels <120 mg/dl.
abstract: Several epidemiologic studies have demonstrated that plasma low-density lipoprotein cholesterol (LDL-C) profile is a key risk indicator for coronary heart disease (CHD). However, almost half of all patients with CHD have normal LDL-C levels. A total of 7,931 male subjects aged ≥40 years from the general population with no cardiovascular history and no use of lipid-lowering agents were followed for incidence of acute myocardial infarction (AMI) and sudden death. Of the 4,827 participants with LDL-C levels <120 mg/dl, 55 subjects had a first AMI/sudden death during an average of 5.5 years of follow-up. After adjustment for confounding factors, multiadjusted hazard ratios (HRs) were increased by 1 SD for non-high-density lipoprotein cholesterol (non-HDL-C; HR = 1.36, 95% confidence interval [CI], 1.02 to 1.81), total cholesterol (TC)/HDL-C ratio (HR = 1.40, 95% CI: 1.11 to 1.78) and LDL-C/HDL-C ratio (HR = 1.32, 95% CI: 1.02 to 1.73) but not for LDL-C (HR = 1.09, 95% CI: 0.82 to 1.44) and HDL-C (HR = 0.84, 95% CI: 0.68 to 1.04). When stratified as categorical variables on the basis of points with highest accuracy on receiver operating characteristic analysis, non-HDL-C levels >126 mg/dl (HR = 1.25, 95% CI: 1.03 to 1.51), TC/HDL-C ratio above 3.5 (HR = 1.22, 95% CI: 1.01 to 1.48) and LDL-C/HDL-C ratio >1.9 (HR = 1.25, 95% CI: 1.04 to 1.51) had increased multiadjusted HRs for AMI/sudden death. In conclusion, in men with LDL-C levels <120 mg/dl, non HDL-C, TC/HDL-C, and LDL-C/HDL-C ratios have predictive value for residual risk of AMI/sudden death.
authors.affiliation: Department of Internal Medicine, Iwate Medical University, Morioka, Japan. Electronic address: xtc@rio.odn.ne.jp.
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Tanaka
authors.forename: Shinji
authors.initials: S
authors.lastname: Makita
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Onoda
authors.forename: Kozo
authors.initials: K
authors.lastname: Tanno
authors.forename: Masaki
authors.initials: M
authors.lastname: Ohsawa
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Itai
authors.forename: Kiyomi
authors.initials: K
authors.lastname: Sakata
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Omama
authors.forename: Yuki
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ogasawara
authors.forename: Akira
authors.initials: A
authors.lastname: Ogawa
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ishibashi
authors.forename: Toru
authors.initials: T
authors.lastname: Kuribayashi
authors.forename: Akira
authors.initials: A
authors.lastname: Okayama
authors.forename: Motoyuki
authors.initials: M
authors.lastname: Nakamura
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D004562:Electrocardiography; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL