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.
Abstract:
Context:
Current guidelines recommend identification and treatment of elevated cholesterol levels, but not of nonfasting triglycerides.
Objective:
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).
Conclusion:
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.
Report:
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.