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Plasma Lipoprotein Levels as Predictors of Cardiovascular Death in Women

Plasma Lipoprotein Levels as Predictors of Cardiovascular Death in Women Abstract Background: The association of lipoprotein levels with cardiovascular disease (CVD) is less well understood in women than in men. To better characterize any relationships, associations between CVD death and total, highdensity lipoprotein (HDL), and low-density lipoprotein (LDL) cholesterol and triglyceride levels in women were explored using data from female participants in the Lipid Research Clinics' Follow-up Study. Methods: Using a sample of 1405 women aged 50 to 69 years from the Lipid Research Clinics' Follow-up Study, age-adjusted CVD death rates and summary relative risk (RR) estimates by categories of lipid and lipoprotein levels were calculated. Multivariate analysis was performed to provide RR estimates adjusted for other CVD risk factors. Results: Average follow-up was 14 years. High-density lipoprotein and triglyceride levels were strong predictors of CVD death in age-adjusted and multivariate analyses. Low-density lipoprotein and total cholesterol levels were poorer predictors of CVD mortality. After adjustment for other CVD risk factors, HDL levels less than 1.30 mmol/L (50 mg/dL) were strongly associated with cardiovascular mortality (RR=1.74; 95% confidence interval [CI], 1.10 to 2.75). Triglyceride levels were associated with increased CVD mortality at levels of 2.25 to 4.49 mmol/L (200 to 399 mg/dL) (RR=1.65; 95% CI, 0.99 to 2.77) and 4.50 mmol/L (400 mg/dL) or greater (RR=3.44; 95% CI, 1.65 to 7.20). At total cholesterol levels of 5.20 mmol/L (200 mg/dL) or greater and at all levels of LDL and triglycerides, women with HDL levels of less than 1.30 mmol/L (<50 mg/dL) had CVD death rates that were higher than those of women with HDL levels of 1.30 mmol/L (50 mg/dL) or greater. Conclusions: High-density lipoprotein and triglyceride levels are independent lipid predictors of CVD death in women. Cholesterol screening guidelines should be reevaluated to reflect the importance of HDL and triglyceride levels in determining CVD risk in women.(Arch Intern Med. 1993;153:2209-2216) References 1. National Center for Health Statistics. Vital Statistics of the United States 1986, II: Mortality, A and B . Washington, DC: US Dept of Health and Human Services; 1988. Publication 88-1122 and 88-1113. 2. Bush TL. The epidemiology of cardiovascular disease in postmenopausal women . Ann N Y Acad Sci . 1990;592:262-271.Crossref 3. Kannel WB, Castelli WP, Gordon T. Cholesterol in the prediction of atherosclerotic disease: new perspectives based on the Framingham Study . Ann Intern Med . 1979;90:85-91.Crossref 4. Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber TR. High-density lipoprotein as a protective factor against coronary heart disease . Am J Med . 1977;62:707-714.Crossref 5. Castelli WP, Doyle JT, Gordon T, et al. HDL cholesterol and other lipids in coronary heart disease: the Cooperative Lipoprotein Phenotyping Study . Circulation . 1977;55:767-772.Crossref 6. Jacobs DR, Mebane IL, Bangdiwala SI, Criqui MH, Tyroler HA. High density lipoprotein cholesterol as a predictor of cardiovascular disease mortality in men and women: the Follow-up Study of the Lipid Research Clinics' Prevalence Study . Am J Epidemiol . 1990;131:32-47. 7. Tyroler HA, Heyden S, Bartel A, et al. Blood pressure and cholesterol as coronary heart disease risk factors . Arch Intern Med . 1971;128:907-914.Crossref 8. Kannel WB. Metabolic risk factors for coronary heart disease in women: perspective from the Framingham Study . Am Heart J . 1987;114:413-419.Crossref 9. Brunner D, Weisbort J, Meshulam N, et al. Relation of serum total cholesterol and high-density lipoprotein cholesterol percentage to the incidence of definite coronary events: twenty-year follow-up of the Donolo—Tel Aviv Prospective Coronary Artery Disease Study . Am J Cardiol . 1987;59:1271-1276.Crossref 10. Barrett-Connor E, Khaw KT, Wingard DL. A ten-year prospective study of coronary heart disease mortality among Rancho Bernardo women . In: Eaker ED, Packard B, Wenger NK, et al, eds. Coronary Heart Disease in Women . New York, NY: Haymarket Doyma; 1987:117-121. 11. Stampfer MJ, Colditz GA, Willett WC, Rosner B, Speizer FE, Hennekens CH. Coronary risk factors in women: the Nurses' Health Study experience . In: Eaker ED, Packard B, Wenger NK, et al, eds. Coronary Heart Disease in Women . New York, NY: Haymarket Doyma; 1987:112-116. 12. Bush TL, Criqui MH, Cowan LD, et al. Cardiovascular disease mortality in women: results from the Lipid Research Clinics' Follow-up Study . In: Eaker ED, Packard B, Wenger NK, et al, eds. Coronary Heart Disease in Women . New York, NY: Haymarket Doyma; 1987:106-111. 13. Lipid Research Clinics' Program Epidemiology Committee. Plasma lipid distributions in selected North American populations: the Lipid Research Clinics' Program Prevalence Study . Circulation . 1979;60:427-439.Crossref 14. Heiss G, Tamir I, Davis CE, et al. Lipoprotein-cholesterol distributions in selected North American populations: the Lipid Research Clinics' Program Prevalence Study . Circulation . 1980;61:302-315.Crossref 15. National Institutes of Health. The Lipid Research Clinics' Population Studies Data Book, I: The Prevalence Study . Bethesda, Md: National Heart, Lung, and Blood Institute; 1980. US Dept of Health and Human Services publication (NIH) 80-1527. 16. National Institutes of Health. Lipid Research Clinics' Program: Manual of Laboratory Operations, I: Lipids and Lipoprotein Analysis . Bethesda, Md: National Heart, Lung, and Blood Institute; 1974. US Dept of Health, Education, and Welfare publication (NIH) 75-628. 17. Breslow NE, Day NE. Rates and rate standardization . In: Breslow NE, Day NE. Statistical Methods in Cancer Research, II: The Design and Analysis of Cohort Studies . Lyon, France: International Agency for Research on Cancer; 1987:52-57. 18. Kahn HA, Sempos CT. Statistical Methods in Epidemiology . New York, NY: Oxford University Press Inc; 1989:219-220. 19. SAS Institute Inc. SAS User's Guide: Basics, Version 5. Cary, NC: SAS Institute Inc; 1985. 20. SAS Institute Inc. SAS/STAT User's Guide, Version 6. 4th ed, vol 2. Cary, NC: SAS Institute Inc; 1989:846. 21. Armitage P, Berry G. Statistical Methods in Medical Research . 2nd ed. Boston, Mass: Blackwell Scientific Publications Inc; 1987:393-394. 22. National Cholesterol Education Program Expert Panel. Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults . Arch Intern Med . 1988;148:36-39.Crossref 23. Castelli WP, Garrison RJ, Wilson PWF, Abbott RD, Kalousdian S, Kannel WB. Incidence of coronary heart disease and lipoprotein cholesterol levels: the Framingham Study . JAMA . 1986;256:2835-2838.Crossref 24. Wallace RB, Anderson RA. Blood lipids, lipid-related measures, and the risk of atherosclerotic cardiovascular disease . Epidemiol Rev . 1987;9:95-119. 25. Lapidus L, Bengtsson C, Lindquist O, Sigurdsson JA, Rybo E. Triglycerides— main risk factor for cardiovascular disease in women? Acta Med Scand . 1985; 217:481-489.Crossref 26. Castelli WP. The triglyceride issue: a view from Framingham . Am Heart J . 1986; 112:432-437.Crossref 27. Sniderman AD, Wolfson C, Teng B, Franklin FA, Bachorik PS, Kwiterovich PO. Association of hyperapobetalipoproteinemia with endogenous hypertriglyceridemia and atherosclerosis . Ann Intern Med . 1982;97:833-839.Crossref 28. Krauss RM. Relationship of intermediate and low-density lipoprotein subspecies to risk of coronary artery disease . Am Heart J . 1987;113:578.Crossref 29. Austin MA, Breslow JL, Hennekens CH, Buring JE, Willett WC, Krauss RM. Low-density lipoprotein subclass patterns and risk of myocardial infarction . JAMA . 1988;260:1917-1921.Crossref 30. Bush TL, Riedel D. Screening for total cholesterol: do the National Cholesterol Education Program's recommendations detect individuals at high risk of coronary heart disease? Circulation . 1991;83:1287-1293.Crossref 31. NIH Consensus Development Panel on Triglyceride, High-Density Lipoprotein, and Coronary Heart Disease. Triglyceride, high-density lipoprotein, and coronary heart disease . JAMA . 1993;269:505-510.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Plasma Lipoprotein Levels as Predictors of Cardiovascular Death in Women

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Publisher
American Medical Association
Copyright
Copyright © 1993 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1993.00410190045006
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Abstract

Abstract Background: The association of lipoprotein levels with cardiovascular disease (CVD) is less well understood in women than in men. To better characterize any relationships, associations between CVD death and total, highdensity lipoprotein (HDL), and low-density lipoprotein (LDL) cholesterol and triglyceride levels in women were explored using data from female participants in the Lipid Research Clinics' Follow-up Study. Methods: Using a sample of 1405 women aged 50 to 69 years from the Lipid Research Clinics' Follow-up Study, age-adjusted CVD death rates and summary relative risk (RR) estimates by categories of lipid and lipoprotein levels were calculated. Multivariate analysis was performed to provide RR estimates adjusted for other CVD risk factors. Results: Average follow-up was 14 years. High-density lipoprotein and triglyceride levels were strong predictors of CVD death in age-adjusted and multivariate analyses. Low-density lipoprotein and total cholesterol levels were poorer predictors of CVD mortality. After adjustment for other CVD risk factors, HDL levels less than 1.30 mmol/L (50 mg/dL) were strongly associated with cardiovascular mortality (RR=1.74; 95% confidence interval [CI], 1.10 to 2.75). Triglyceride levels were associated with increased CVD mortality at levels of 2.25 to 4.49 mmol/L (200 to 399 mg/dL) (RR=1.65; 95% CI, 0.99 to 2.77) and 4.50 mmol/L (400 mg/dL) or greater (RR=3.44; 95% CI, 1.65 to 7.20). At total cholesterol levels of 5.20 mmol/L (200 mg/dL) or greater and at all levels of LDL and triglycerides, women with HDL levels of less than 1.30 mmol/L (<50 mg/dL) had CVD death rates that were higher than those of women with HDL levels of 1.30 mmol/L (50 mg/dL) or greater. Conclusions: High-density lipoprotein and triglyceride levels are independent lipid predictors of CVD death in women. Cholesterol screening guidelines should be reevaluated to reflect the importance of HDL and triglyceride levels in determining CVD risk in women.(Arch Intern Med. 1993;153:2209-2216) References 1. National Center for Health Statistics. Vital Statistics of the United States 1986, II: Mortality, A and B . Washington, DC: US Dept of Health and Human Services; 1988. Publication 88-1122 and 88-1113. 2. Bush TL. The epidemiology of cardiovascular disease in postmenopausal women . Ann N Y Acad Sci . 1990;592:262-271.Crossref 3. Kannel WB, Castelli WP, Gordon T. Cholesterol in the prediction of atherosclerotic disease: new perspectives based on the Framingham Study . Ann Intern Med . 1979;90:85-91.Crossref 4. Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber TR. High-density lipoprotein as a protective factor against coronary heart disease . Am J Med . 1977;62:707-714.Crossref 5. Castelli WP, Doyle JT, Gordon T, et al. HDL cholesterol and other lipids in coronary heart disease: the Cooperative Lipoprotein Phenotyping Study . Circulation . 1977;55:767-772.Crossref 6. Jacobs DR, Mebane IL, Bangdiwala SI, Criqui MH, Tyroler HA. High density lipoprotein cholesterol as a predictor of cardiovascular disease mortality in men and women: the Follow-up Study of the Lipid Research Clinics' Prevalence Study . Am J Epidemiol . 1990;131:32-47. 7. Tyroler HA, Heyden S, Bartel A, et al. Blood pressure and cholesterol as coronary heart disease risk factors . Arch Intern Med . 1971;128:907-914.Crossref 8. Kannel WB. Metabolic risk factors for coronary heart disease in women: perspective from the Framingham Study . Am Heart J . 1987;114:413-419.Crossref 9. Brunner D, Weisbort J, Meshulam N, et al. Relation of serum total cholesterol and high-density lipoprotein cholesterol percentage to the incidence of definite coronary events: twenty-year follow-up of the Donolo—Tel Aviv Prospective Coronary Artery Disease Study . Am J Cardiol . 1987;59:1271-1276.Crossref 10. Barrett-Connor E, Khaw KT, Wingard DL. A ten-year prospective study of coronary heart disease mortality among Rancho Bernardo women . In: Eaker ED, Packard B, Wenger NK, et al, eds. Coronary Heart Disease in Women . New York, NY: Haymarket Doyma; 1987:117-121. 11. Stampfer MJ, Colditz GA, Willett WC, Rosner B, Speizer FE, Hennekens CH. Coronary risk factors in women: the Nurses' Health Study experience . In: Eaker ED, Packard B, Wenger NK, et al, eds. Coronary Heart Disease in Women . New York, NY: Haymarket Doyma; 1987:112-116. 12. Bush TL, Criqui MH, Cowan LD, et al. Cardiovascular disease mortality in women: results from the Lipid Research Clinics' Follow-up Study . In: Eaker ED, Packard B, Wenger NK, et al, eds. Coronary Heart Disease in Women . New York, NY: Haymarket Doyma; 1987:106-111. 13. Lipid Research Clinics' Program Epidemiology Committee. Plasma lipid distributions in selected North American populations: the Lipid Research Clinics' Program Prevalence Study . Circulation . 1979;60:427-439.Crossref 14. Heiss G, Tamir I, Davis CE, et al. Lipoprotein-cholesterol distributions in selected North American populations: the Lipid Research Clinics' Program Prevalence Study . Circulation . 1980;61:302-315.Crossref 15. National Institutes of Health. The Lipid Research Clinics' Population Studies Data Book, I: The Prevalence Study . Bethesda, Md: National Heart, Lung, and Blood Institute; 1980. US Dept of Health and Human Services publication (NIH) 80-1527. 16. National Institutes of Health. Lipid Research Clinics' Program: Manual of Laboratory Operations, I: Lipids and Lipoprotein Analysis . Bethesda, Md: National Heart, Lung, and Blood Institute; 1974. US Dept of Health, Education, and Welfare publication (NIH) 75-628. 17. Breslow NE, Day NE. Rates and rate standardization . In: Breslow NE, Day NE. Statistical Methods in Cancer Research, II: The Design and Analysis of Cohort Studies . Lyon, France: International Agency for Research on Cancer; 1987:52-57. 18. Kahn HA, Sempos CT. Statistical Methods in Epidemiology . New York, NY: Oxford University Press Inc; 1989:219-220. 19. SAS Institute Inc. SAS User's Guide: Basics, Version 5. Cary, NC: SAS Institute Inc; 1985. 20. SAS Institute Inc. SAS/STAT User's Guide, Version 6. 4th ed, vol 2. Cary, NC: SAS Institute Inc; 1989:846. 21. Armitage P, Berry G. Statistical Methods in Medical Research . 2nd ed. Boston, Mass: Blackwell Scientific Publications Inc; 1987:393-394. 22. National Cholesterol Education Program Expert Panel. Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults . Arch Intern Med . 1988;148:36-39.Crossref 23. Castelli WP, Garrison RJ, Wilson PWF, Abbott RD, Kalousdian S, Kannel WB. Incidence of coronary heart disease and lipoprotein cholesterol levels: the Framingham Study . JAMA . 1986;256:2835-2838.Crossref 24. Wallace RB, Anderson RA. Blood lipids, lipid-related measures, and the risk of atherosclerotic cardiovascular disease . Epidemiol Rev . 1987;9:95-119. 25. Lapidus L, Bengtsson C, Lindquist O, Sigurdsson JA, Rybo E. Triglycerides— main risk factor for cardiovascular disease in women? Acta Med Scand . 1985; 217:481-489.Crossref 26. Castelli WP. The triglyceride issue: a view from Framingham . Am Heart J . 1986; 112:432-437.Crossref 27. Sniderman AD, Wolfson C, Teng B, Franklin FA, Bachorik PS, Kwiterovich PO. Association of hyperapobetalipoproteinemia with endogenous hypertriglyceridemia and atherosclerosis . Ann Intern Med . 1982;97:833-839.Crossref 28. Krauss RM. Relationship of intermediate and low-density lipoprotein subspecies to risk of coronary artery disease . Am Heart J . 1987;113:578.Crossref 29. Austin MA, Breslow JL, Hennekens CH, Buring JE, Willett WC, Krauss RM. Low-density lipoprotein subclass patterns and risk of myocardial infarction . JAMA . 1988;260:1917-1921.Crossref 30. Bush TL, Riedel D. Screening for total cholesterol: do the National Cholesterol Education Program's recommendations detect individuals at high risk of coronary heart disease? Circulation . 1991;83:1287-1293.Crossref 31. NIH Consensus Development Panel on Triglyceride, High-Density Lipoprotein, and Coronary Heart Disease. Triglyceride, high-density lipoprotein, and coronary heart disease . JAMA . 1993;269:505-510.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 11, 1993

References