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Lipid-related markers and cardiovascular disease prediction.

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Citation: JAMA. 307(23):2499-506, 2012 Jun 20.PMID: 22797450Institution: MedStar Washington Hospital CenterDepartment: Medicine/General Internal MedicineForm of publication: Journal ArticleMedline article type(s): Journal Article | Research Support, Non-U.S. Gov'tSubject headings: *Biological Markers/bl [Blood] | *Cardiovascular Diseases/bl [Blood] | *Cardiovascular Diseases/ep [Epidemiology] | *Lipoproteins/bl [Blood] | Aged | Cholesterol, HDL/bl [Blood] | Cohort Studies | Female | Humans | Male | Middle Aged | Risk AssessmentLocal holdings: Available online from MWHC library: 1998 - present, Available in print through MWHC library: 1999 - presentISSN:

0098-7484

Name of journal: JAMA : the journal of the American Medical AssociationAbstract: CONCLUSION: In a study of individuals without known CVD, the addition of information on the combination of apolipoprotein B and A-I, lipoprotein(a), or lipoprotein-associated phospholipase A2 mass to risk scores containing total cholesterol and HDL-C led to slight improvement in CVD prediction.CONTEXT: The value of assessing various emerging lipid-related markers for prediction of first cardiovascular events is debated.DESIGN, SETTING, AND PARTICIPANTS: Individual records were available for 165,544 participants without baseline CVD in 37 prospective cohorts (calendar years of recruitment: 1968-2007) with up to 15,126 incident fatal or nonfatal CVD outcomes (10,132 CHD and 4994 stroke outcomes) during a median follow-up of 10.4 years (interquartile range, 7.6-14 years).MAIN OUTCOME MEASURES: Discrimination of CVD outcomes and reclassification of participants across predicted 10-year risk categories of low (<10%), intermediate (10%-<20%), and high (>=20%) risk.OBJECTIVE: To determine whether adding information on apolipoprotein B and apolipoprotein A-I, lipoprotein(a), or lipoprotein-associated phospholipase A2 to total cholesterol and high-density lipoprotein cholesterol (HDL-C) improves cardiovascular disease (CVD) risk prediction.RESULTS: The addition of information on various lipid-related markers to total cholesterol, HDL-C, and other conventional risk factors yielded improvement in the model's discrimination: C-index change, 0.0006 (95% CI, 0.0002-0.0009) for the combination of apolipoprotein B and A-I; 0.0016 (95% CI, 0.0009-0.0023) for lipoprotein(a); and 0.0018 (95% CI, 0.0010-0.0026) for lipoprotein-associated phospholipase A2 mass. Net reclassification improvements were less than 1% with the addition of each of these markers to risk scores containing conventional risk factors. We estimated that for 100,000 adults aged 40 years or older, 15,436 would be initially classified at intermediate risk using conventional risk factors alone. Additional testing with a combination of apolipoprotein B and A-I would reclassify 1.1%; lipoprotein(a), 4.1%; and lipoprotein-associated phospholipase A2 mass, 2.7% of people to a 20% or higher predicted CVD risk category and, therefore, in need of statin treatment under Adult Treatment Panel III guidelines.All authors: Assmann G, Ballantyne CM, Barrett-Connor E, Boekholdt SM, Brunner E, Butterworth AS, Casiglia E, Caslake M, Clarke R, Cooper JA, D'Agostino RB Sr, Dagenais GR, Danesh J, Di Angelantonio E, Ducimetiere P, Dullaart RP, Emerging Risk Factors Collaboration, Ford I, Fowkes FG, Gallacher J, Gao P, Gillum RF, Gomez-de-la-Camara A, Gudnason V, Hofman A, Howard WJ, Jukema JW, Kaptoge S, Kauhanen J, Khaw KT, Kiechl S, Koenig W, Kromhout D, Nagel D, Nordestgaard BG, Onat A, Packard C, Pennells L, Psaty BM, Ridker PM, Rosengren A, Saleheen D, Salomaa V, Salonen JT, Sandhu M, Sarwar N, Sattar N, Simons LA, Sundstrom J, Sutherland SE, Thompson A, Thompson SG, Tipping RW, Wareham NJ, Wood AM, Wormser DDigital Object Identifier:

http://dx.doi.org/10.1001/jama.2012.6571

Date added to catalog: 2013-09-17

Holdings ( 1 )
Title notes ( 8 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article		Available		22797450

Available online from MWHC library: 1998 - present, Available in print through MWHC library: 1999 - present

CONCLUSION: In a study of individuals without known CVD, the addition of information on the combination of apolipoprotein B and A-I, lipoprotein(a), or lipoprotein-associated phospholipase A2 mass to risk scores containing total cholesterol and HDL-C led to slight improvement in CVD prediction.

CONTEXT: The value of assessing various emerging lipid-related markers for prediction of first cardiovascular events is debated.

DESIGN, SETTING, AND PARTICIPANTS: Individual records were available for 165,544 participants without baseline CVD in 37 prospective cohorts (calendar years of recruitment: 1968-2007) with up to 15,126 incident fatal or nonfatal CVD outcomes (10,132 CHD and 4994 stroke outcomes) during a median follow-up of 10.4 years (interquartile range, 7.6-14 years).

MAIN OUTCOME MEASURES: Discrimination of CVD outcomes and reclassification of participants across predicted 10-year risk categories of low (<10%), intermediate (10%-<20%), and high (>=20%) risk.

OBJECTIVE: To determine whether adding information on apolipoprotein B and apolipoprotein A-I, lipoprotein(a), or lipoprotein-associated phospholipase A2 to total cholesterol and high-density lipoprotein cholesterol (HDL-C) improves cardiovascular disease (CVD) risk prediction.

RESULTS: The addition of information on various lipid-related markers to total cholesterol, HDL-C, and other conventional risk factors yielded improvement in the model's discrimination: C-index change, 0.0006 (95% CI, 0.0002-0.0009) for the combination of apolipoprotein B and A-I; 0.0016 (95% CI, 0.0009-0.0023) for lipoprotein(a); and 0.0018 (95% CI, 0.0010-0.0026) for lipoprotein-associated phospholipase A2 mass. Net reclassification improvements were less than 1% with the addition of each of these markers to risk scores containing conventional risk factors. We estimated that for 100,000 adults aged 40 years or older, 15,436 would be initially classified at intermediate risk using conventional risk factors alone. Additional testing with a combination of apolipoprotein B and A-I would reclassify 1.1%; lipoprotein(a), 4.1%; and lipoprotein-associated phospholipase A2 mass, 2.7% of people to a 20% or higher predicted CVD risk category and, therefore, in need of statin treatment under Adult Treatment Panel III guidelines.

English