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Serum Lipid Screening to Identify High-Risk Individuals for Coronary Death: The Results of the Lipid Research Clinics Prevalence Cohort

Serum Lipid Screening to Identify High-Risk Individuals for Coronary Death: The Results of the... Abstract Objective: To assess the accuracy of specific plasma lipid fractions in predicting coronary heart disease (CHD) mortality among adults. Methods: Follow-up data for a random sample of 30- to 79-year-old men and women recruited into the Lipid Research Clinics Prevalence and Follow-up Studies were included in this analysis (n=4499). Baseline measurements of total plasma cholesterol and lipoprotein fractions were compared with subsequent CHD mortality after a mean follow-up of 12.3 years. The areas under receiver operating characteristic curves for specific serum lipids were compared for individuals aged 30 to 59 and 60 to 79 years. Main Results: For the younger cohort, the ratio of total cholesterol to high-density lipoprotein cholesterol was a better predictor (P<.05) of CHD mortality (receiver operating characteristic curve area, 0.80±0.03) than was total cholesterol level alone (receiver operating characteristic curve area, 0.73±0.03) or any other single lipoprotein measurement. Among the older cohort, the same screening strategies performed poorly, with receiver operating characteristic curve areas ranging from 0.51±0.05 for total cholesterol to 0.64±0.05 for the ratio of low-density to high-density lipoprotein cholesterol levels. Conclusion: Plasma lipid levels are poor predictors of coronary death among those aged 60 to 79 years without known CHD. These data indicate the need to define better lipid screening strategies for older, asymptomatic adults. Among younger adults aged 30 to 59 years, high-density lipoprotein cholesterol measurement should be included as part of any lipid screening program, as the ratio of total to high-density lipoprotein cholesterol levels is the best lipid screening test to identify those at high risk for subsequent CHD mortality.(Arch Intern Med. 1994;154:679-684) References 1. Bush TL, Riedel D. Screening for total cholesterol: do the National Cholesterol Screening Program's recommendations detect individuals at high risk of coronary heart disease? Circulation . 1991;83:1287-1293.Crossref 2. Simons LA. Interrelations of lipids and lipoproteins with coronary artery disease mortality in 19 countries . Am J Cardiol . 1986;57:5G-10G.Crossref 3. 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 4. Lipid Research Clinics Program. The Lipid Research Clinics Coronary Primary Prevention Trial results, I: reduction in incidence of coronary heart disease . JAMA . 1984;251:351-364.Crossref 5. Grundy SM. Cholesterol and coronary heart disease: future directions . JAMA . 1990;264:3053-3059.Crossref 6. 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 7. Castelli WP, Anderson K. A population at risk: prevalence of high cholesterol levels in hypertensive patients in the Framingham Study . Am J Med . 1986;80 ( (suppl 2A) ):23-32.Crossref 8. Neil HAW, Mant D, Jones L, Morgan B, Mann JI. Lipid screening: is it enough to measure total cholesterol concentration? BMJ . 1990;301:584-587.Crossref 9. Goldbourt G, Holtzman E, Neufeld HN. Total and high density lipoprotein cholesterol in the serum and risk of mortality: evidence of a threshold effect . BMJ . 1985;290:1239-1243.Crossref 10. National Cholesterol Education Program. Report of the Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults . Arch Intern Med . 1988;148:36-69.Crossref 11. Central Patient Registry and Coordinating Center for the Lipid Research Clinics. Reference Manual for the Lipid Research Clinics Prevalence Study, Vols. 1 and 2 . Chapel Hill, NC: Dept of Biostatistics, University of North Carolina; (February) 1974. 12. Lipid Research Clinics Program Epidemiology Committee. Plasma lipid distributions in selected North American populations: the Lipid Research Clinics Prevalence Study . Circulation . 1979;60:427-439.Crossref 13. 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 14. Lipid Research Clinics Program. Manual of Laboratory Operations, Vol. 1: Lipid and Lipoprotein Analysis . Bethesda, Md: National Heart, Lung, and Blood Institute, National Institutes of Health; 1974. US Dept of Health, Education, and Welfare publication (NIH) 75-628. 15. Jacobs DR Jr, Melbane IL, Bangdiwala SI, Criqui MH, Tyroler HA, Lipid Research Clinics Program. 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. 16. Davis CE, Rifkind BM, Brenner H, et al. A single cholesterol measurement underestimates the risk of coronary heart disease: an empirical example from the Lipid Research Clinics Mortality Follow-up Study . JAMA . 1990;264:3044-3052.Crossref 17. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve . Radiology . 1982;143:29-36.Crossref 18. Metz CE, Wang PL, Kronman HB. A new approach for testing the significance of differences between ROC curves measured from correlated data . In: Deconinck F, ed. Information Processing in Medical Imaging . The Hague, the Netherlands: Nijhoff; 1984:432-445. 19. Shepherd J, Betteridge DJ, Durrington P, et al. Strategies for reducing coronary heart disease and desirable limits for blood lipid concentrations: guidelines of the British Hyperlipidaemia Association . BMJ . 1987;295:1245-1246.Crossref 20. Canadian Consensus Conference on Cholesterol: Final report: the Canadian Consensus Conference on the Prevention of Heart and Vascular Disease by Altering Serum Cholesterol and Lipoprotein Risk Factors . Can Med Assoc J . 1988; 139( (suppl to No. 11) ):1-8. 21. Cooper GR, Myers GL, Smith SJ, Schlant RC. Blood lipid measurements: variations and practical utility . JAMA . 1992;267:1652-1660.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Serum Lipid Screening to Identify High-Risk Individuals for Coronary Death: The Results of the Lipid Research Clinics Prevalence Cohort

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Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1994.00420060113012
Publisher site
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Abstract

Abstract Objective: To assess the accuracy of specific plasma lipid fractions in predicting coronary heart disease (CHD) mortality among adults. Methods: Follow-up data for a random sample of 30- to 79-year-old men and women recruited into the Lipid Research Clinics Prevalence and Follow-up Studies were included in this analysis (n=4499). Baseline measurements of total plasma cholesterol and lipoprotein fractions were compared with subsequent CHD mortality after a mean follow-up of 12.3 years. The areas under receiver operating characteristic curves for specific serum lipids were compared for individuals aged 30 to 59 and 60 to 79 years. Main Results: For the younger cohort, the ratio of total cholesterol to high-density lipoprotein cholesterol was a better predictor (P<.05) of CHD mortality (receiver operating characteristic curve area, 0.80±0.03) than was total cholesterol level alone (receiver operating characteristic curve area, 0.73±0.03) or any other single lipoprotein measurement. Among the older cohort, the same screening strategies performed poorly, with receiver operating characteristic curve areas ranging from 0.51±0.05 for total cholesterol to 0.64±0.05 for the ratio of low-density to high-density lipoprotein cholesterol levels. Conclusion: Plasma lipid levels are poor predictors of coronary death among those aged 60 to 79 years without known CHD. These data indicate the need to define better lipid screening strategies for older, asymptomatic adults. Among younger adults aged 30 to 59 years, high-density lipoprotein cholesterol measurement should be included as part of any lipid screening program, as the ratio of total to high-density lipoprotein cholesterol levels is the best lipid screening test to identify those at high risk for subsequent CHD mortality.(Arch Intern Med. 1994;154:679-684) References 1. Bush TL, Riedel D. Screening for total cholesterol: do the National Cholesterol Screening Program's recommendations detect individuals at high risk of coronary heart disease? Circulation . 1991;83:1287-1293.Crossref 2. Simons LA. Interrelations of lipids and lipoproteins with coronary artery disease mortality in 19 countries . Am J Cardiol . 1986;57:5G-10G.Crossref 3. 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 4. Lipid Research Clinics Program. The Lipid Research Clinics Coronary Primary Prevention Trial results, I: reduction in incidence of coronary heart disease . JAMA . 1984;251:351-364.Crossref 5. Grundy SM. Cholesterol and coronary heart disease: future directions . JAMA . 1990;264:3053-3059.Crossref 6. 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 7. Castelli WP, Anderson K. A population at risk: prevalence of high cholesterol levels in hypertensive patients in the Framingham Study . Am J Med . 1986;80 ( (suppl 2A) ):23-32.Crossref 8. Neil HAW, Mant D, Jones L, Morgan B, Mann JI. Lipid screening: is it enough to measure total cholesterol concentration? BMJ . 1990;301:584-587.Crossref 9. Goldbourt G, Holtzman E, Neufeld HN. Total and high density lipoprotein cholesterol in the serum and risk of mortality: evidence of a threshold effect . BMJ . 1985;290:1239-1243.Crossref 10. National Cholesterol Education Program. Report of the Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults . Arch Intern Med . 1988;148:36-69.Crossref 11. Central Patient Registry and Coordinating Center for the Lipid Research Clinics. Reference Manual for the Lipid Research Clinics Prevalence Study, Vols. 1 and 2 . Chapel Hill, NC: Dept of Biostatistics, University of North Carolina; (February) 1974. 12. Lipid Research Clinics Program Epidemiology Committee. Plasma lipid distributions in selected North American populations: the Lipid Research Clinics Prevalence Study . Circulation . 1979;60:427-439.Crossref 13. 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 14. Lipid Research Clinics Program. Manual of Laboratory Operations, Vol. 1: Lipid and Lipoprotein Analysis . Bethesda, Md: National Heart, Lung, and Blood Institute, National Institutes of Health; 1974. US Dept of Health, Education, and Welfare publication (NIH) 75-628. 15. Jacobs DR Jr, Melbane IL, Bangdiwala SI, Criqui MH, Tyroler HA, Lipid Research Clinics Program. 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. 16. Davis CE, Rifkind BM, Brenner H, et al. A single cholesterol measurement underestimates the risk of coronary heart disease: an empirical example from the Lipid Research Clinics Mortality Follow-up Study . JAMA . 1990;264:3044-3052.Crossref 17. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve . Radiology . 1982;143:29-36.Crossref 18. Metz CE, Wang PL, Kronman HB. A new approach for testing the significance of differences between ROC curves measured from correlated data . In: Deconinck F, ed. Information Processing in Medical Imaging . The Hague, the Netherlands: Nijhoff; 1984:432-445. 19. Shepherd J, Betteridge DJ, Durrington P, et al. Strategies for reducing coronary heart disease and desirable limits for blood lipid concentrations: guidelines of the British Hyperlipidaemia Association . BMJ . 1987;295:1245-1246.Crossref 20. Canadian Consensus Conference on Cholesterol: Final report: the Canadian Consensus Conference on the Prevention of Heart and Vascular Disease by Altering Serum Cholesterol and Lipoprotein Risk Factors . Can Med Assoc J . 1988; 139( (suppl to No. 11) ):1-8. 21. Cooper GR, Myers GL, Smith SJ, Schlant RC. Blood lipid measurements: variations and practical utility . JAMA . 1992;267:1652-1660.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Mar 28, 1994

References