title: Long-term risk of cardiovascular events across a spectrum of adverse major plasma lipid combinations in the Framingham Heart Study.
abstract: BACKGROUND
  Blood levels of high low-density lipoprotein cholesterol (LDL-C), high triglycerides (TG), and low high-density lipoprotein cholesterol (HDL-C) have been associated with increased risk of cardiovascular disease (CVD). The long-term comparative CVD risk associated with these 3 major lipid classes in various combinations is, however, unknown.
  
  
  METHODS
  A total of 3,501 participants of the Framingham Offspring Study (mean age 51 ± 10 years, 56% women) without CVD at baseline were followed up for incident CVD between 1987 and 2011. Participants were grouped according to baseline lipid values into 8 distinct categories to compare the prognostic significance of values within an optimal range to Third Report of the National Cholesterol Educational Program-defined high LDL-C (> 130 mg/dL), high TG (> 150 mg/dL), and/or low HDL-C (< 40 mg/dL) in various combinations using multivariable-adjusted Cox regression models.
  
  
  RESULTS
  On follow-up (median 20.2 years), 724 (21%) had new-onset CVD. Adjusted for confounders and compared with the group with optimal lipid values, hazards ratios and population-attributable risks (PARs) were as follows: isolated low HDL-C, 1.93 (95% CI 1.37-2.71), PAR = 3.1%; isolated high LDL-C, 1.28 (1.03-1.59), PAR 6.4%; isolated high TG, 1.35 (0.91-1.98), PAR = 1.1% (not significant); low HDL-C and high LDL-C, 1.82 (1.33-2.49), PAR = 3.9%; low HDL-C and high TG, 1.74 (1.28-2.37), PAR = 3.9%; high LDL-C and high TG, 1.52 (1.12-2.07), PAR = 6.4%; and high LDL-C, high TG and low HDL-C 2.28 (1.73-3.02), PAR = 7.5%.
  
  
  CONCLUSIONS
  Aside from isolated hypertriglyceridemia, low levels of HDL-C, high levels of LDL-C, and high levels of TG in any combination were associated with increased risk of CVD.
authors.affiliation: Framingham Heart Study, Framingham, MA; Boston University School of Medicine, Boston, MA.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Andersson
authors.affiliation: Framingham Heart Study, Framingham, MA; Department of Mathematics and Statistics, Boston University, Boston, MA.
authors.forename: Asya
authors.initials: A
authors.lastname: Lyass
authors.affiliation: Framingham Heart Study, Framingham, MA; Section of Preventive Medicine and Cardiology, Boston University School of Medicine, Boston, MA.
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
authors.affiliation: Framingham Heart Study, Framingham, MA; Department of Biostatistics, Boston University School of Public Health, Boston, MA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Massaro
authors.affiliation: Framingham Heart Study, Framingham, MA; Department of Mathematics and Statistics, Boston University, Boston, MA.
authors.forename: Ralph B
authors.initials: RB
authors.lastname: D'Agostino
authors.affiliation: Framingham Heart Study, Framingham, MA; Boston University School of Medicine, Boston, MA.
authors.forename: Sander J
authors.initials: SJ
authors.lastname: Robins
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D015331:Cohort Studies; D050171:Dyslipidemias / Q000097:blood / Q000150:complications / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic / Q000379:methods / Q000458:organization & administration; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013995:Time; D014280:Triglycerides / Q000097:blood*; D014481:United States / Q000453:epidemiology
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D014280:Triglycerides