|Title||Association of High-Density Lipoprotein-Cholesterol Versus Apolipoprotein A-I With Risk of Coronary Heart Disease: The European Prospective Investigation Into Cancer-Norfolk Prospective Population Study, the Atherosclerosis Risk in Communities Study, and|
|Publication Type||Journal Article|
|Year of Publication||2017|
|Authors||van Capelleveen JC, Bochem AE, S Boekholdt M, Mora S, Hoogeveen RC, Ballantyne CM, Ridker PM, Sun W, Barter PJ, Tall AR, Zwinderman AH, Kastelein JJP, Wareham NJ, Khaw K-T|
|Secondary Authors||G Hovingh K|
|Journal||J Am Heart Assoc|
|Date Published||2017 Aug 03|
|Keywords||Aged, Antineoplastic Agents, Apolipoprotein A-I, Aspirin, Cardiovascular Diseases, Cholesterol, HDL, Coronary Disease, Double-Blind Method, England, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Neoplasms, Platelet Aggregation Inhibitors, Prognosis, Prospective Studies, Risk Factors, Vitamin E, Women's Health|
BACKGROUND: The contribution of apolipoprotein A-I (apoA-I) to coronary heart disease (CHD) risk stratification over and above high-density lipoprotein cholesterol (HDL-C) is unclear. We studied the associations between plasma levels of HDL-C and apoA-I, either alone or combined, with risk of CHD events and cardiovascular risk factors among apparently healthy men and women.
METHODS AND RESULTS: HDL-C and apoA-I levels were measured among 17 661 participants of the EPIC (European Prospective Investigation into Cancer)-Norfolk prospective population study. Hazard ratios for CHD events and distributions of risk factors were calculated by quartiles of HDL-C and apoA-I. Results were validated using data from the ARIC (Atherosclerosis Risk in Communities) and WHS (Women's Health Study) cohorts, comprising 15 494 and 27 552 individuals, respectively. In EPIC-Norfolk, both HDL-C and apoA-I quartiles were strongly and inversely associated with CHD risk. Within HDL-C quartiles, higher apoA-I levels were not associated with lower CHD risk; in fact, CHD risk was higher within some HDL-C quartiles. ApoA-I levels were associated with higher levels of CHD risk factors: higher body mass index, HbA1c, non-HDL-C, triglycerides, apolipoprotein B, systolic blood pressure, and C-reactive protein, within fixed HDL-C quartiles. In contrast, HDL-C levels were consistently inversely associated with overall CHD risk and CHD risk factors within apoA-I quartiles (
CONCLUSIONS: Our findings demonstrate that apoA-I levels do not offer predictive information over and above HDL-C. In fact, within some HDL-C quartiles, higher apoA-I levels were associated with higher risk of CHD events, possibly because of the unexpected higher prevalence of cardiovascular risk factors in association with higher apoA-I levels.
CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00000479.
|Alternate Journal||J Am Heart Assoc|
|PubMed Central ID||PMC5586475|
|Grant List||MR/N003284/1 / MRC_ / Medical Research Council / United Kingdom |
G1000143 / MRC_ / Medical Research Council / United Kingdom
MC_UU_12015/1 / MRC_ / Medical Research Council / United Kingdom
G0401527 / MRC_ / Medical Research Council / United Kingdom
UM1 CA182913 / CA / NCI NIH HHS / United States
R01 CA047988 / CA / NCI NIH HHS / United States
R01 HL080467 / HL / NHLBI NIH HHS / United States
R01 HL117861 / HL / NHLBI NIH HHS / United States
RC1 HL099355 / HL / NHLBI NIH HHS / United States