Abstract 166: Small Dense LDL Cholesterol Is Associated with Risk for Coronary Heart Disease: The Atherosclerosis Risk in Communities (ARIC) Study

2012 ◽  
Vol 32 (suppl_1) ◽  
Author(s):  
John W Gaubatz ◽  
Wensheng Sun ◽  
Jennifer Jiang ◽  
Ashley Buchanan ◽  
David Couper ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Proportional Hazards ◽  
Ldl Cholesterol ◽  
Proportional Hazards Model ◽  
Small Dense Ldl ◽  
Traditional Risk Factors ◽  
Aric Study

Background— Evidence from in vitro studies indicates that small dense LDL (sd-LDL) is more atherogenic than large buoyant LDL. Previously, sd-LDL has been associated with risk for vascular disease. However, the lack of a standardized sd-LDL assay has hampered its clinical application. Objectives— We tested the hypothesis that elevated plasma sd-LDL-cholesterol (sd-LDL-C) level is associated with risk for incident coronary heart disease (CHD) and stroke in the ARIC cohort. Methods— Plasma sd-LDL-C was measured in 11,419 men and women of the biracial ARIC study using a newly developed automated homogeneous assay. A proportional hazards model was used to examine the relationship between sd-LDL-C, vascular risk factors, and risk for CHD events and stroke over a period of ≈10 years. Results— Mean plasma sd-LDL-C was higher in Caucasians than in African Americans (45.2 vs. 37.4 mg/dL, p<0.0001). Plasma sd-LDL-C levels were strongly correlated with an atherogenic lipid profile and were higher in diabetics vs. non-diabetics (49.6 vs. 42.3 mg/dL, p<0.0001, respectively). sd-LDL-C was associated with incident CHD in a basic model as well as a model that included traditional risk factors and hs-CRP with hazard ratios (HRs) of 1.99 (95%CI: 1.68-2.36) and 1.56 (95%CI: 1.26-1.93) for the highest vs. the lowest quartile, respectively (Table). We did not find a significant association of sd-LDL-C with risk for stroke (Table). Conclusions— sd-LDL-C is associated with incident CHD but does not predict risk for stroke in ARIC participants. Further studies will need to determine whether sd-LDL-C will add value beyond traditional risk factors to cardiovascular risk assessment in clinical practice.

scholarly journals CHD Risk Factors In African-Americans

Circulation ◽  
2001 ◽  
Vol 103 (suppl_1) ◽  
pp. 1347-1347
Author(s):  
Daniel W Jones ◽  
Lloyd E Chambless ◽  
Aaron R Folsom ◽  
Richard G Hutchinson ◽  
Richey A Sharrett ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Risk Factor ◽  
Heart Disease ◽  
Black Women ◽  
African Americans ◽  
Racial Differences ◽  
Ldl Cholesterol ◽  
Traditional Risk Factors ◽  
Chd Risk Factors

0017 Few studies have reported the incidence of coronary heart disease and its relationship to risk factors in African-Americans. As part of the Atherosclerosis Risk in Communities Study, baseline risk factors were tested as predictors of incident coronary heart disease over 7-10 years of follow-up, 1987-1997, in four U.S. communities (Forsyth County, North Carolina; Jackson, Mississippi; Minneapolis, Minnesota; and Washington County, Maryland). The sample included 14,026 men and women (2,298 black women [BW]; 5,686 white women [WW]; 1,396 black men [BM]; and 4,682 white men [WM] aged 45-64 who were free of clinical coronary heart disease at baseline. Age-adjusted incidence rates for the 7-10 year period (95% confidence interval) for coronary heart disease were BW 5.0(4.1-6.1), WW 4.0(3.5-4.6), BM 10.7(8.9-12.8), and WM 12.6(11.5-13.8). In multivariate analysis, traditional risk factors were generally predictive in blacks as in whites. Hypertension was a particularly strong risk factor in black women, with hazard rate ratios (HR) being: BW 4.12, WW 2.0, BM 1.85, and WM 1.59. Diabetes was predictive, but HRs were somewhat less in blacks than in whites: BW 1.88, WW 3.34, BM 1.70, and WW 2.14. LDL cholesterol was similarly predictive in all race/gender groups, HR 1.19-1.36 per S.D. LDL cholesterol increment. HDL cholesterol appeared somewhat more protective in whites than in blacks. Although black/white differences in risk factor associations exist, there were more similarities than differences in coronary heart disease risk factors and incidence. Findings from this study, along with clinical trial evidence showing efficacy, support aggressive management of traditional risk factors in blacks as in whites. Understanding of the intriguing racial differences in risk factor prediction may be an important part of further understanding the causes of coronary heart disease and may lead to better methods of prevention and treatment.

Abstract 5090: Impact of Adding a Single Allele in the 9p21 Locus to Traditional Risk Factors on Risk Classification for Coronary Heart Disease and Implications for Lipid-Modifying Therapy in the White Population of the Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Ariel Brautbar ◽  
Christie Ballantyne ◽  
Kim Lawson ◽  
Vijay Nambi ◽  
Lloyd Chambless ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Risk Prediction ◽  
White Population ◽  
Atherosclerosis Risk In Communities ◽  
Chd Risk ◽  
Atherosclerosis Risk ◽  
Traditional Risk Factors ◽  
Aric Study

Aim: A single nucleotide polymorphism on chromosome 9p21, rs10757274 (9p21 allele), has been shown to be a predictor of coronary heart disease (CHD) in whites. We evaluated if the addition of the 9p21 allele to traditional risk factors (TRF) improved CHD risk prediction in the white population of the Atherosclerosis Risk in Communities (ARIC) study, and whether changes in risk prediction will modify lipid therapy recommendation. Methods: Whites (n=10,004) in the ARIC study for whom the 9p21 genotype and TRF (age, gender, systolic blood pressure, total cholesterol, smoking, diabetes, HDL-C, and anti-hypertensive medication use) information was available were included. Using Cox proportional hazards models, the ARIC Cardiovascular Risk Score (ACRS) which is based on TRF was determined. The impact of adding the 9p21 allele to TRF with respect to the area under the curve (AUC) of a receiver operating characteristic (ROC) curve and then risk strata reclassification was determined. Results: The addition of 9p21 allele to TRF was associated with a hazard ratio (HR) of 1.25 (p<0.0001) and an increase in the AUC for incident CHD from 0.776 to 0.780 (Δ= 0.004, 95% CI=0.001, 0.008). The 9p21 allele’s greatest influence to the ACRS (Table ) was observed in the intermediate (5–10% 10-year CHD risk) and intermediate-high (10 –20% 10-year CHD risk) categories with 19.3% and 16.9% reclassified, respectively, which would impact therapy, as approximately 90% of these individuals had LDL-C >100 mg/dL. Table: Reclassification in the different ACRS categories after the addition of the 9p21 allele to the traditional risk factors

Cardiac biomarkers for cardiovascular risk prediction among women and men from the general population

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
F Zhu ◽  
B Arshi ◽  
E Aribas ◽  
MA Ikram ◽  
MK Ikram ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Risk ◽  
Predictive Value ◽  
Troponin T ◽  
Cardiac Biomarkers ◽  
C Statistic ◽  
Cardiovascular Risk Prediction ◽  
Traditional Risk Factors

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): the Erasmus Medical Center and Erasmus University Rotterdam; the Netherlands Organization for Health Research and Development (ZonMw); Purpose To evaluate the sex-specific predictive value of two cardiac biomarkers; N-terminal pro B-type natriuretic peptide (NT-proBNP) and high sensitivity cardiac troponin T (hs-cTnT), alongside traditional cardiovascular risk factors, for 10-year cardiovascular risk prediction in general population. Methods A total of 5430 participants (mean age 68.1 years; 59.9% women) free of cardiovascular disease (CVD), with blood sample measurements between 1997 and 2001 were included. We developed a ‘base’ model using cardiovascular risk factors used in the Pooled Cohort Equation (includes age, sex, systolic blood pressure, treatment of hypertension, total and high-density lipoprotein cholesterol levels, smoking, and diabetes) and then extended the ‘base’ model with NT-proBNP or hs-cTnT. These models were developed for coronary heart disease (CHD), stroke, and heart failure (HF) and also for composite CVD outcomes. To evaluate biomarkers’ added predictive value, c-statistic, and net reclassification improvement index (NRI) for events and non-events were calculated. NRI was calculated using cutoffs of 5%, 7.5% and 20% to categorize participants as low, borderline, intermediate, or high risk. Results Adding NT-proBNP to the ‘base’ model significantly improved c-statistic for all outcomes (increases ranged between 0.012-0.047), with the largest improvement in HF [0.026 (95% CI, 0.013, 0.040) for women and 0.047 (95% CI, 0.026, 0.069) for men]. Adding hs-TnT to ‘base’ model increased the c-statistic for CHD in women by 0.040 (95% CI, 0.013, 0.067) and for HF in men by 0.032 (95% CI, 0.005, 0.059). Improvments in reclassification by both biomarkers were mostly limited to modest improvemetns in reclassification of non-events [largest non-event NRI for global CVD in women (NT-proBNP: 11.8%; hs-cTnT: 10.5%) and for HF in men (NT-proBNP: 9.6%; hs-cTnT: 8.4%)]. Conclusion NT-proBNP improved model performance for prediction of all cardiovascular outcomes, in particular for HF, beyond traditional risk factors for both women and men. Hs-cTnT showed modest added predictive value beyond traditional risk factors for CHD among women and for HF among men. Imropovements in reclassification by both biomarkers were modest and not clinically relevant. Improvements of 10-year risk predictions Events Adding NT-proBNP Adding troponin T Delta c-statistic* Event NRI, % Non-event NRI, % Delta c-statistic* Event NRI, % Non-event NRI, % WomenASCVD Global CVD 0.012 (0.004, 0.020) 0.018 (0.010, 0.026) -1.7 (-5.0, 1.5)-0.8 (-3.8, 2.2) 5.4 (3.5, 7.2)11.8 (9.6, 14.1) 0.028 (0.009, 0.048)0.025 (0.009, 0.040) -0.4 (-7.1, 6.2)2.9 (-2.4, 8.3) 6.9 (3.9, 9.9)10.5 (7.3, 13.8) MenASCVD Global CVD 0.016 (0.005, 0.027)0.023 (0.012, 0.033) 0.7 (-2.3, 3.7)-0.3 (-3.0, 2.4) 5.2 (3.2, 7.2)7.2 (4.9, 9.4) 0.007 (-0.002, 0.016)0.011 (0.000, 0.021) -1.1 (-5.0, 2.7)-1.6 (-6.0, 2.8) 4.0 (1.2, 6.9)6.4 (3.1, 9.7) ASCVD comprises coronary heart disease and stroke; Global CVD comprises coronary heart disease, stroke and heart failure.

Abstract P323: Pulse Pressure and Incident Acute Coronary Heart Disease Events in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Stephen P Glasser ◽  
Daniel L Halberg ◽  
Charles Sands ◽  
Paul Muntner ◽  
Monika Safford
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Racial Differences ◽  
Pulse Pressure ◽  
Proportional Hazards ◽  
Linear Trend ◽  
Cox Proportional Hazards ◽  
Cvd Risk

Background: Increased attention has been given to pulse pressure (PP) as a potential independent risk factor of cardiovascular disease. We examined the relationship between PP and incident acute coronary heart disease (CHD). Methods: We used data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) national cohort study of 30,239 black and white participants aged 45 years or older and enrolled between 2003 and 2007. Baseline data included a 45-minute interview and in-home visit during which blood pressure was assessed and recorded as the average of two measurements obtained after a 5 minute seated rest. PP (SBP-DBP) was classified into 4 groups (<45, 45-54, 54.1-64, >64.1 mmHg). Telephone follow-up occurred every six months for self or proxy-reported suspected events, triggering medical record retrieval and adjudication by experts. Cox-proportional hazards models examined the association of incident CHD with PP groups, adjusting for socio-demographic and clinical risk factors. Results: This analysis included 22,909 participants free of CHD at baseline, with mean age 64.7±9.4 years; 40.4%were black, 44.6% were male and they experienced a total of 515 incident CHD events over a mean 3.4 yrs of follow-up (maximum 6 years). In unadjusted analyses, compared with PP<45 mmHg, each higher PP group had incrementally higher hazard ratios (HR) for incident CHD (HR 1.28 {95% CI 1.02-1.60}, 2.05 {1.63-2.56}, 3.82 {3.08-4.74}, p<0.001 for linear trend). This relationship persisted after fully adjusting including SBP for the highest PP group (HR 0.96 {0.75-1.21}, 1.12 {0.86-1.46}, 1.51 {1.09-2.10}, p trend <0.0001). Conclusions: High PP was associated with incident CHD, even when accounting for SBP and numerous other CVD risk factors.

scholarly journals Correlation of Lipoprotein (a) Level with Complexity of Coronary Lesion in Coronary Heart Disease Patient at RSUP Dr. Sardjito Yogyakarta

2016 ◽  
Vol 15 (3) ◽  
pp. 362-367
Author(s):  
Iin Novita Nurhidayati Mahmuda ◽  
Lucia Kris Dinarti ◽  
Nahar Taufiq
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Angina Pectoris ◽  
Disease Patient ◽  
Coronary Vessel ◽  
Syntax Score ◽  
Lipoprotein A ◽  
Traditional Risk Factors

Background: In 2020 there were estimated to be 25 million deaths each year from cardiovascular disease; most of them being coronary heart disease. Traditional risk factors such as smoking, hypertension, diabetes, dyslipidemia reported to affect only 50% of the prevalence and degree of coronary heart disease. It pushes a lot of research on non-traditional risk factors one of which is lipoprotein (a). Levels of Lp (a) also reflects the degree of severity and is associated with the number of coronary arteries involved. The purpose of this study was to determine the relationship of Lp (a) level with the complexity of coronary artery lesion.Methods: This was a cross-sectional study. Subjects were male and women patients aged between 20 to 60 years who underwent coronary angiography for theirs STEMI, NSTEMI, unstable angina pectoris, and stable angina pectoris. Correlation between elevated Lp (a) with the complexity of coronary artery lesion was performed by Pearson test. If the distribution was abnormal we used Spearman test.Result: Number of samples was 64 subjects (49 men and 15 women). The result showed a significant positive correlation between Lp (a) level and complexity of coronary vessel lesion that counted by SYNTAX score (p 0,004) even though the coefficient correlation is weak (r 0, 33).Conclusion: The higher Lp (a) level shows bigger SYNTAX score which means the coronary vessel lesion more complex.Bangladesh Journal of Medical Science Vol.15(3) 2016 p.362-367

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