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Copenhagen City Heart: Nonfasting cholesterol and triglycerides, myocardial infarction, and early death

Clinical Trial Update II

Acute Coronary Syndromes (ACS)

Presenter | see Discussant report

Borge Nordestgaard, (Denmark)

List of Authors:
Anne Langsted, MD, Jacob J Freiberg, MD, Anne Tybjærg-Hansen, MD, DMSc, Peter Schnohr, MD, DMSc, Gorm B Jensen, MD, DMSc, and Børge G Nordestgaard MD, DMSc.


Current guidelines recommend identification and treatment of elevated cholesterol levels, but not of nonfasting triglycerides.

We compared the ability of cholesterol and triglycerides measured nonfasting at random to predict risk of myocardial infarction and total mortality.

Design, setting, and participants:
We followed 7581 women and 6391 men aged 20 to 93 years from the Danish general population for 31 years. Among women, 768 developed myocardial infarction and 4398 died; corresponding numbers in men were 1151 and 4416. Follow-up was 100% complete. Main outcome measures: Plasma cholesterol and triglycerides measured nonfasting at random, lipoproteins, traditional cardiovascular risk factors and endpoints. Results: Elevated nonfasting total cholesterol mainly marked elevated low density lipoprotein cholesterol levels while elevated nonfasting triglyceride levels mainly marked elevated remnant lipoprotein cholesterol levels.

Compared to women with cholesterol <5mmol/L, multivariate adjusted hazard ratios for myocardial infarction ranged from 1.3(95%CI 0.9-1.8) for cholesterol of 5-5.99 mmol/L to 2.5 (1.6-4.0) for cholesterol =9mmol/L (trend p<0.0001), while compared with women with nonfasting triglycerides <1 mmol/L, hazard ratios ranged from 1.5 (1.2-1.8) for triglycerides of 1-1.99 mmol/L to 4.2(2.5-7.2) for triglycerides =5mmol/L (p<0.0001). In men, corresponding hazard ratios ranged from 1.2 (1.0-1.5) to 5.3 (3.6-8.0) for cholesterol (p<0.0001), and from 1.3(1.0-1.6) to 2.1 (1.5-2.8) for triglycerides (p<0.0001). Increasing cholesterol levels did not consistently associate with total mortality in women (trend p=0.39) or men (p=0.02).

In contrast, compared with women with triglycerides <1 mmol/L, multivariate adjusted hazard ratios for total mortality ranged from 1.1 (1.0-1.2) for triglycerides of 1-1.99 mmol/L to 2.0(1.5-2.9) for triglycerides =5mmol/L (trend p<0.0001); corresponding hazard ratios in men ranged from 1.1(1.0-1.2) to 1.5(1.2-1.7) (p<0.0001).

Stepwise increasing levels of both nonfasting cholesterol and nonfasting triglycerides associate with stepwise increasing risk of myocardial infarction; however, only increasing levels of nonfasting triglycerides consistently associate with total mortality.


Discussant | see Presenter abstract

Valentin Fuster, FESC (United States of America)






Nonfasting cholesterol and triglycerides, myocardial infarction, and early death. Copenhagen City Heart

Notes to editor

This congress report accompanies a presentation given at the ESC Congress 2009. Written by the author himself/herself, this report does not necessarily reflect the opinion of the European Society of Cardiology.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.