Clinical Utility of Different Lipid Measures for Prediction of Coronary Heart Disease in Men and Women

作者：Erik Ingelsson, Ernst J. Schaefer, John H. Contois, Judith R McNamara, LISA M. SULLIVAN, Michelle J. Keyes, Michael J. Pencina, Christopher Schoonmaker, Peter W.F. Wilson, Ralph B. D’Agostino, Ramachandran Srini Vasan · 发表于：JAMA · 年份：2007 · DOI：10.1001/jama.298.7.776 · 被引用次数：611 · 研究领域：Diabetes, Cardiovascular Risks, and Lipoproteins、Lipoproteins and Cardiovascular Health、HIV-related health complications and treatments

CONTEXT: Evidence is conflicting regarding the performance of apolipoproteins vs traditional lipids for predicting coronary heart disease (CHD) risk. OBJECTIVES: To compare performance of different lipid measures for CHD prediction using discrimination and calibration characteristics and reclassification of risk categories; to assess incremental utility of apolipoproteins over traditional lipids for CHD prediction. DESIGN, SETTING, AND PARTICIPANTS: Population-based, prospective cohort from, Framingham, Massachusetts. We evaluated serum total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, apolipoprotein (apo) A-I and apo B, and 3 lipid ratios (total cholesterol:HDL-C, LDL-C:HDL-C, and apo B:apo A-I) in 3322 middle-aged white participants who attended the fourth offspring examination cycle (1987-1991) and were without cardiovascular disease. Fifty-three percent of the participants were women. MAIN OUTCOME MEASURE: Incidence of first CHD event (recognized or unrecognized myocardial infarction, angina pectoris, coronary insufficiency, or coronary heart disease death). RESULTS: After a median follow-up of 15.0 years, 291 participants, 198 of whom were men, developed CHD. In multivariate models adjusting for nonlipid risk factors, the apo B:apo A-I ratio predicted CHD (hazard ratio [HR] per SD increment, 1.39; 95% confidence interval [CI], 1.23-1.58 in men and HR, 1.40; 95% CI, 1.16-1.67 in women), but risk ratios...