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LDL subfractions are associated with incident cardiovascular disease in the Malmö Prevention Project Study

Shiffman, Dov; Louie, Judy Z; Caulfield, Michael P; Nilsson, Peter M. LU ; Devlin, James J and Melander, Olle LU (2017) In Atherosclerosis 263. p.287-292
Abstract

Background and aims After assessing the risk for cardiovascular disease (CVD) based on traditional risk factors, decisions concerning lipid lowering therapy might remain uncertain. To investigate whether lipoprotein subfraction levels could aid these decisions, we assessed the association between lipoprotein subfractions and CVD, after adjustment for traditional risk factors including standard lipids. Methods Using a case-cohort design, participants were randomly drawn from the Malmö Prevention Project (MPP), a population-based prospective study of 18,240 participants, and supplemented with additional incident CVD events (5764 participants, 1784 CVD events). Results Low density lipoprotein particle number (LDL-P) and individual... (More)

Background and aims After assessing the risk for cardiovascular disease (CVD) based on traditional risk factors, decisions concerning lipid lowering therapy might remain uncertain. To investigate whether lipoprotein subfraction levels could aid these decisions, we assessed the association between lipoprotein subfractions and CVD, after adjustment for traditional risk factors including standard lipids. Methods Using a case-cohort design, participants were randomly drawn from the Malmö Prevention Project (MPP), a population-based prospective study of 18,240 participants, and supplemented with additional incident CVD events (5764 participants, 1784 CVD events). Results Low density lipoprotein particle number (LDL-P) and individual subfractions ranging in size from very-small to large were associated with CVD (continuous p value (pcont) < 0.001) while adjusting for age, sex, hypertension, smoking, and diabetes. After further adjustment for LDL-C, HDL-C, and triglycerides, very small LDL subfraction (b) (LDL-VS (b)) remained associated with CVD (HR = 1.23, 95% CI, 1.06 to 1.43 for top vs. bottom quartile, pcont = 0.03). Among participants with low/intermediate risk [without diabetes and with LDL-C <3.36 mmol/L (<130 mg/dL)], the fully adjusted HR for LDL-small (top vs. bottom quartile) was 1.48 (95% CI 1.02 to 2.17, pcont = 0.03). Among those with very-high risk (>20% 10-year risk of CVD), LDL-VS(a) and LDL-VS(b) were associated with CVD in fully adjusted models (HR = 1.37, 95% CI 1.12 to 1.67 and HR = 1.28, 95% CI 1.07 to 1.53, respectively, pcont≤0.03). Conclusions Smaller LDL particles are associated with incident CVD independently of traditional risk factors, including standard lipids, in participants with low/intermediate and very-high risk, who might benefit from improved risk assessment.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cardiovascular diseases, Lipoproteins, Primary prevention, Prospective studies, Risk factors
in
Atherosclerosis
volume
263
pages
6 pages
publisher
Elsevier
external identifiers
  • scopus:85024396350
  • wos:000407634000914
ISSN
0021-9150
DOI
10.1016/j.atherosclerosis.2017.07.003
language
English
LU publication?
yes
id
9f2cb6a4-9e41-4592-abaa-7aec02c2a0b4
date added to LUP
2017-07-31 10:50:19
date last changed
2018-01-07 12:13:35
@article{9f2cb6a4-9e41-4592-abaa-7aec02c2a0b4,
  abstract     = {<p>Background and aims After assessing the risk for cardiovascular disease (CVD) based on traditional risk factors, decisions concerning lipid lowering therapy might remain uncertain. To investigate whether lipoprotein subfraction levels could aid these decisions, we assessed the association between lipoprotein subfractions and CVD, after adjustment for traditional risk factors including standard lipids. Methods Using a case-cohort design, participants were randomly drawn from the Malmö Prevention Project (MPP), a population-based prospective study of 18,240 participants, and supplemented with additional incident CVD events (5764 participants, 1784 CVD events). Results Low density lipoprotein particle number (LDL-P) and individual subfractions ranging in size from very-small to large were associated with CVD (continuous p value (p<sub>cont</sub>) &lt; 0.001) while adjusting for age, sex, hypertension, smoking, and diabetes. After further adjustment for LDL-C, HDL-C, and triglycerides, very small LDL subfraction (b) (LDL-VS (b)) remained associated with CVD (HR = 1.23, 95% CI, 1.06 to 1.43 for top vs. bottom quartile, p<sub>cont</sub> = 0.03). Among participants with low/intermediate risk [without diabetes and with LDL-C &lt;3.36 mmol/L (&lt;130 mg/dL)], the fully adjusted HR for LDL-small (top vs. bottom quartile) was 1.48 (95% CI 1.02 to 2.17, p<sub>cont</sub> = 0.03). Among those with very-high risk (&gt;20% 10-year risk of CVD), LDL-VS(a) and LDL-VS(b) were associated with CVD in fully adjusted models (HR = 1.37, 95% CI 1.12 to 1.67 and HR = 1.28, 95% CI 1.07 to 1.53, respectively, p<sub>cont</sub>≤0.03). Conclusions Smaller LDL particles are associated with incident CVD independently of traditional risk factors, including standard lipids, in participants with low/intermediate and very-high risk, who might benefit from improved risk assessment.</p>},
  author       = {Shiffman, Dov and Louie, Judy Z and Caulfield, Michael P and Nilsson, Peter M. and Devlin, James J and Melander, Olle},
  issn         = {0021-9150},
  keyword      = {Cardiovascular diseases,Lipoproteins,Primary prevention,Prospective studies,Risk factors},
  language     = {eng},
  month        = {08},
  pages        = {287--292},
  publisher    = {Elsevier},
  series       = {Atherosclerosis},
  title        = {LDL subfractions are associated with incident cardiovascular disease in the Malmö Prevention Project Study},
  url          = {http://dx.doi.org/10.1016/j.atherosclerosis.2017.07.003},
  volume       = {263},
  year         = {2017},
}