title: Hierarchical modelling of blood lipids' profile and 10-year (2002-2012) all cause mortality and incidence of cardiovascular disease: the ATTICA study.
abstract: BACKGROUND
  The traditional view on the relationship between lipid biomarkers and CVD risk has changed during the last decade. However, it is not clear whether novel lipid biomarkers are able to confer a better predictability of CVD risk, compared to traditional ones.Under this perspective, the aim of the present work was to evaluate the predictive ability of blood lipids' profile on all cause mortality as well as 10-year incidence of CVD, in a sample of apparently healthy adults of the ATTICA epidemiological study.
  
  
  METHODS
  From May 2001 to December 2002, 1514 men and 1528 women (>18 y) without any clinical evidence of any other chronic disease, at baseline, were enrolled. In 2011-12, the 10-year follow-up was performed in 2583 participants (85 % follow-up participation rate). Incidence of fatal or non-fatal CVD was defined according to WHO-ICD-10 criteria. Baseline serum blood lipids' profile (Total-C, HDL-, non HDL-, LDL-cholesterol, triglycerides (TG), apolipoprotein (Apo)A1 and B, and lipoprotein-(a) levels were also measured.
  
  
  RESULTS
  The 10-year all-cause mortality rate was 5.7 % for men and 2.0 % for women (p = 0.55). The, 10-year CVD incidence was 19.7 % in men and 11.7 % in women (p < 0.001). Multi-adjusted analysis revealed that TC, non-HDL-C, TG and TG/HDL-C ratio, were independent predictors of all cause mortality (RR per 1 mg/dL or unit (95 % CI): 1.006 (1.000-1.013), 1.006 (1.000-1.013), 1.002 (1.000-1.004), 1.038 (1.001-1.077), respectively). Moreover, TC, HDL-, LDL-, non-HDL-cholesterol, TG, apoA1, TC/HDL-C and TG/HDL-C were independently associated with CVD risk. Among all lipid indices the ratio of apoB/apoA1 demonstrated the best correct reclassification ability, followed by non-HDL-C and TC/HDL-C ratio (continuous Net Reclassification Index 26.1 and 21.2 %, respectively).
  
  
  CONCLUSIONS
  Elevated levels of lipid biomarkers are independently associated with all-cause mortality, as well as CVD risk. The ratio of apoB/apoA1, followed by non-HDL-C, demonstrated the best correct classification ability of the developed CVD risk models.
authors.affiliation: Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
authors.forename: Tzortzis
authors.initials: T
authors.lastname: Nomikos
authors.affiliation: Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece. d.b.panagiotakos@usa.net.|, 46 Paleon Polemiston St., Glyfada, Attica, 166 74, Greece. d.b.panagiotakos@usa.net.
authors.forename: Demosthenes
authors.initials: D
authors.lastname: Panagiotakos
authors.affiliation: Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
authors.forename: Ekavi
authors.initials: E
authors.lastname: Georgousopoulou
authors.affiliation: First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece.
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Metaxa
authors.affiliation: First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Chrysohoou
authors.affiliation: First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Skoumas
authors.affiliation: Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
authors.forename: Smaragdi
authors.initials: S
authors.lastname: Antonopoulou
authors.affiliation: First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tousoulis
authors.affiliation: First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece.
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
authors.affiliation: First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Pitsavos
mesh_terms: D000328:Adult; D000368:Aged; D016632:Apolipoprotein A-I / Q000097:blood*; D001055:Apolipoproteins B / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D017270:Lipoprotein(a) / Q000097:blood; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D012306:Risk; D016019:Survival Analysis; D014280:Triglycerides / Q000097:blood
chemical_list: C505693:APOA1 protein, human; D016632:Apolipoprotein A-I; D001055:Apolipoproteins B; D015415:Biomarkers; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D017270:Lipoprotein(a); D014280:Triglycerides