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Remnants represent incompletely hydrolyzed, triglyceride enriched lipoproteins such as very low-density lipoprotein fraction 3 (VLDL3) and intermediate-density lipoprotein (IDL) and are believed to be atherogenic.Hypothesis: In the Framingham Offspring Study (FOS), remnant lipoproteins are associated with increased risk for incident CHD (inclusive of coronary death, MI, coronary insufficiency, and angina pectoris).
Vertical auto profile measurements were performed on 819 men and women without prevalent cardiovascular disease. The relationship between VLDL3, IDL, and the sum of VLDL3 + IDL (total remnants) and 12-year risk for CHD was examined using multivariable Cox proportional hazard regression for two models adjusted for Framingham risk factors (model 1 adjusts for age, sex, systolic blood pressure and use of antihypertensives, prevalent diabetes, and smoking; model 2 adjusts for model 1 risk factors, HDL-C, and TC).
In model 1, VLDL3 (HR 1.43; 95% CI 1.12-1.82, p<0.004), IDL (HR 1.39; 95% CI 1.07-1.80, p<0.014), and total remnants (HR 1.43; 95% CI 1.11-1.85, p<0.032) were all significant predictors of incident CHD. In model 2, VLDL3 lost significance (HR 1.30; 95% CI 0.96-1.75, p<0.089), but IDL (HR 1.39; 955 CI 1.03-1.82, p<0.03) and total remnants (HR 1.37; 95% CI 1.03-1.84, p<0.032) remained significant predictors for incident CHD. Non-HDL-C which broadly includes all atherogenic lipoproteins including remnants was significant in both model 1 ((HR 1.42; 95% CI 1.09-1.83, p<0.008) and model 2 (HR 1.46; 95% CI 1.02-2.08, p<0.037).
In this exploratory analysis, after controlling for Framingham risk factors in men and women, remnant lipoproteins are independent risk factors for incident CHD events over 12 years of follow-up in the FOS, though VLDL3 lost significance after controlling for all Framingham covariates.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Prevention: Lipoproteins, Particles and Ratios
Abstract Category: 24. Prevention: Clinical
Presentation Number: 1145-4
- 2013 American College of Cardiology Foundation