title: Lipoprotein particles and size, total and high molecular weight adiponectin, and leptin in relation to incident coronary heart disease among severely obese postmenopausal women: The Women's Health Initiative Observational Study.
abstract: BACKGROUND
  We hypothesized that higher concentrations of LDL particles (LDL-P) and leptin, and lower concentrations of HDL particles (HDL-P), and total and high molecular weight (HMW) adiponectin, would predict incident coronary heart disease (CHD) among severely obese postmenopausal women.
  
  
  METHODS
  In a case-cohort study nested in the Women's Health Initiative Observational Study, we sampled 677 of the 1852 white or black women with body mass index (BMI) ≥40 kg/m2and no prevalent cardiovascular disease (CVD), including all 124 cases of incident CHD over mean 5.0 year follow-up. Biomarkers were assayed on stored blood samples.
  
  
  RESULTS
  In multivariable-adjusted weighted Cox models, higher baseline levels of total and small LDL-P, and lower levels of total and medium HDL-P, and smaller mean HDL-P size were significantly associated with incident CHD. In contrast, large HDL-P levels were inversely associated with CHD only for women without diabetes, and higher total and HMW adiponectin levels and lower leptin levels were associated with CHD only for women with diabetes. Higher total LDL-P and lower HDL-P were associated with CHD risk independently of confounders including CV risk factors and other lipoprotein measures, with adjusted HR (95%CIs) of 1.55(1.28, 1.88) and (0.70 (0.57, 0.85), respectively, and similar results for medium HDL-P.
  
  
  CONCLUSIONS
  Higher CHD risk among severely obese postmenopausal women is strongly associated with modifiable concentrations of LDL-P and HDL-P, independent of diabetes, smoking, hypertension, physical activity, BMI and waist circumference.
  
  
  CONCLUSIONS
  Severely obese postmenopausal women should be considered high risk candidates for lipid lowering therapy.
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh PA.
authors.forename: Rachel H
authors.initials: RH
authors.lastname: Mackey
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh PA ; Department of Medicine, University of Pittsburgh, Pittsburgh PA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: McTigue
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh PA ; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Yuefang F
authors.initials: YF
authors.lastname: Chang
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh PA.
authors.forename: Emma
authors.initials: E
authors.lastname: Barinas-Mitchell
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh PA.
authors.forename: Rhobert W
authors.initials: RW
authors.lastname: Evans
authors.affiliation: Department of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle WA.
authors.forename: Lesley F
authors.initials: LF
authors.lastname: Tinker
authors.affiliation: Department of Medicine, University of Alabama at Birmingham.
authors.forename: Cora E
authors.initials: CE
authors.lastname: Lewis
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston MA.
authors.forename: JoAnn E
authors.initials: JE
authors.lastname: Manson
authors.affiliation: Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford CA.
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Stefanick
authors.affiliation: Medstar Health Research Institute, Hyattsville, MD.
authors.forename: Barbara V
authors.initials: BV
authors.lastname: Howard
authors.affiliation: Clinical Studies Center, Atlanta VA Medical Center, Decatur, GA and Division of Endocrinology, Emory University School of Medicine, Atlanta, GA.
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Phillips
authors.affiliation: Department of Epidemiology, Brown University, Providence, RI.
authors.forename: Simin
authors.initials: S
authors.lastname: Liu
authors.affiliation: Mayo Clinic Arizona, Phoenix, AZ.
authors.forename: Doina
authors.initials: D
authors.lastname: Kulick
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh PA.
authors.forename: Lewis H
authors.initials: LH
authors.lastname: Kuller
keywords: adiponectin; coronary heart disease; extreme obesity; lipoproteins; postmenopausal women; severe obesity
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