Elevated Remnant Cholesterol Reclassifies Risk of Ischemic Heart Disease and Myocardial Infarction

被引:85
作者
Doi, Takahito [1 ,2 ,3 ,4 ]
Langsted, Anne [1 ,2 ,3 ]
Nordestgaard, Borge G. [1 ,2 ,3 ]
机构
[1] Copenhagen Univ Hosp, Herlev & Gentofte Hosp, Dept Clin Biochem, Borgmester Ib Juuls Vej 73, DK-2730 Herlev, Denmark
[2] Copenhagen Univ Hosp, Herlev & Gentofte Hosp, Copenhagen Gen Populat Study, Herlev, Denmark
[3] Univ Copenhagen, Fac Hlth & Med Sci, Dept Clin Med, Copenhagen, Denmark
[4] Natl Cerebral & Cardiovasc Ctr, Dept Cardiovasc Med, Suita, Osaka, Japan
关键词
atherosclerotic cardiovascular disease; primary prevention; reclassification; triglyceride-rich lipoproteins; very-low-density lipoprotein; DENSITY-LIPOPROTEIN CHOLESTEROL; LDL CHOLESTEROL; ARTERIAL INTIMA; IN-VIVO; TRIGLYCERIDES; PLASMA; VARIANTS;
D O I
10.1016/j.jacc.2022.03.384
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND Elevated remnant cholesterol causes ischemic heart disease. OBJECTIVES We tested the hypothesis that the inclusion of elevated remnant cholesterol will lead to appropriate reclassification of individuals who later experience myocardial infarction and ischemic heart disease. METHODS For >10 years we followed up 41,928 white Danish individuals from the Copenhagen General Population Study without a history of ischemic cardiovascular disease, diabetes, and statin use. Using predefined cut points for elevated remnant cholesterol, we calculated net reclassification index (NRI) from below to above 5%, 7.5%, and/or 10% 10-year occurrence of myocardial infarction and ischemic heart disease defined as a composite of death from ischemic heart disease, myocardial infarction, and coronary revascularization. RESULTS For individuals with remnant cholesterol levels >= 95th percentile (>= 1.6 mmol/L, 61 mg/dL), 23% (P < 0.001) of myocardial infarction and 21% (P < 0.001) of ischemic heart disease were reclassified correctly from below to above 5% for 10-year occurrence when remnant cholesterol levels were added to models based on conventional risk factors, whereas no events were reclassified incorrectly. Consequently, the addition of remnant cholesterol levels yielded NRI of 10% (95% CI: 1%-20%) for myocardial infarction and 5% (95% CI: similar to 3% to 13%) for ischemic heart disease. Correspondingly, when reclassifications were combined from below to above 5%, 7.5%, and 10% risk of events, 42% (P < 0.001) of individuals with myocardial infarction and 41% (P < 0.001) with ischemic heart disease were reclassified appropriately, leading to NRI of respectively 20% (95% CI: 9%-31%) and 11% (95% CI: 2%-21%). CONCLUSIONS Elevated remnant cholesterol levels considerably improve myocardial infarction and ischemic heart disease risk prediction. (C) 2022 by the American College of Cardiology Foundation.
引用
收藏
页码:2383 / 2397
页数:15
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