Author + information
- Received April 17, 2009
- Revision received June 16, 2009
- Accepted July 12, 2009
- Published online December 29, 2009.
- Benoit J. Arsenault, PhD⁎,†,
- Jamal S. Rana, MD, PhD§,
- Erik S.G. Stroes, MD, PhD∥,
- Jean-Pierre Després, PhD⁎,‡,
- Prediman K. Shah, MD§,
- John J.P. Kastelein, MD, PhD∥,
- Nicholas J. Wareham, MBBS, PhD#,
- S. Matthijs Boekholdt, MD, PhD¶,⁎ ( and )
- Kay-Tee Khaw, MBBChir⁎⁎
- ↵⁎Reprint requests and correspondence:
Dr. S. Matthijs Boekholdt, Academic Medical Center, Department of Cardiology, P.O. Box 22660, 1100 DD, Amsterdam, the Netherlands
Objectives This study was designed to test the hypothesis that at any low-density lipoprotein cholesterol (LDL-C) level, other lipid parameters such as non–high-density lipoprotein cholesterol (HDL-C) levels, triglyceride (TG) levels, and the total cholesterol (TC)/HDL-C are still associated with an increased coronary heart disease (CHD) risk.
Background Although LDL-C is considered to be the primary target of lipid-lowering therapy, other parameters of the lipoprotein-lipid profile may more closely associated with CHD risk.
Methods In the EPIC (European Prospective Investigation Into Cancer and Nutrition)-Norfolk prospective population study, 21,448 participants without diabetes or CHD between age 45 and 79 years were followed for 11.0 years. A total of 2,086 participants developed CHD during follow-up.
Results Among individuals with low LDL-C levels (<100 mg/dl), after adjustment for age, sex, smoking, systolic blood pressure, waist circumference, physical activity, and hormone replacement therapy (in women), those with non–HDL-C >130 mg/dl had a hazard ratio (HR) for future CHD of 1.84 (95% confidence interval [CI]: 1.12 to 3.04) when compared with those with non–HDL-C levels <130 mg/dl. In a similar model, individuals with TG levels >150 mg/dl had an HR of 1.63 (95% CI: 1.02 to 2.59) when compared with those with TG levels <150 mg/dl, and individuals with a TC/HDL-C ratio >5 had an HR of 2.19 (95% CI: 1.22 to 3.93) when compared with those with a TC/HDL-C ratio <5.
Conclusions In this prospective study, independently of their plasma LDL-C levels, participants with high non–HDL-C levels, high TG levels, or with an elevated TC/HDL-C ratio were at increased CHD risk. CHD risk assessment algorithms as well as lipid targets of lipid-lowering trials may also need to consider other easily available parameters such as non–HDL-C.
- low-density lipoprotein cholesterol
- non–high-density lipoprotein cholesterol
- total to high-density lipoprotein cholesterol ratio
- coronary heart disease
The EPIC-Norfolk study is supported by program grants from the Medical Research Council U.K. and Cancer Research U.K. and with additional support from the European Union, Stroke Association, British Heart Foundation, and Research into Ageing. Drs. Arsenault and Rana contributed equally to this work.
- Received April 17, 2009.
- Revision received June 16, 2009.
- Accepted July 12, 2009.
- American College of Cardiology Foundation