Journal
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
Volume 307, Issue 23, Pages 2499-2506Publisher
AMER MEDICAL ASSOC
DOI: 10.1001/jama.2012.6571
Keywords
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Categories
Funding
- British Heart Foundation
- European Union
- Lead-up Medical Network
- Merck Sharp and Dohme
- John Wiley Son
- Elsevier (France)
- Medical Research Council
- UK National Institute of Health Research
- Cambridge Biomedical Research Centre
- Roche
- GlaxoSmithKline
- National Institute of Health
- Wellcome Trust
- Abbott
- Amarin
- AstraZeneca
- Bristol-Myers Squibb
- Gentech
- Kowa
- Merck
- Novartis
- Sanofi-Synthelabo
- Takeda
- National Institutes of Health
- American Diabetes Association
- American Heart Association
- Adnexus
- Amylin
- Esperion
- Genetech
- Idera Pharma, Kowa
- Omthera
- Pfizer
- Resverlogix
- Medtronic
- Vascular Bio-genics
- ISIS Inc
- Genzyme
- Else Kroner Fresenius Foundation
- Vifor Company
- Federal Ministry of Education and Research
- Boehringer Ingelheim
- Cerenis
- BioInvet
- National Heart, Lung, and Blood Institute
- National Institute of Diabetes and Digestive and Kidney Diseases
- Canadian Institutes Health Research
- Heart and Stroke of Canada
- Netherlands Prevention Foundation
- Swedish Research Council
- Swedish Heart and Lung Foundation
- BUPA Foundation
- Denka
- diaDexus
- European Research Council
- Evelyn Trust
- Fogarty International Centre
- UK Biobank
- MRC [G0501792, G0601284, G0701619, MC_U137686857, G0701863, MC_U105260792, G0902037] Funding Source: UKRI
- British Heart Foundation [RG/08/014/24067, RG/07/008/23674, RG/08/013/25942] Funding Source: researchfish
- Medical Research Council [G0401527, G8802774, G0701619, MC_U106179471, G0902037, MC_U105260792, MC_U137686857, G1000143, G0701863, G0601284, G0501792, G0100222, G19/35] Funding Source: researchfish
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Context The value of assessing various emerging lipid-related markers for prediction of first cardiovascular events is debated. Objective To determine whether adding information on apolipoprotein B and apolipoprotein A-I, lipoprotein(a), or lipoprotein-associated phospholipase A(2) to total cholesterol and high-density lipoprotein cholesterol (HDL-C) improves cardiovascular disease (CVD) risk prediction. Design, Setting, and Participants Individual records were available for 165 544 participants without baseline CVD in 37 prospective cohorts (calendar years of recruitment: 1968-2007) with up to 15 126 incident fatal or nonfatal CVD outcomes (10 132 CHD and 4994 stroke outcomes) during a median follow-up of 10.4 years (interquartile range, 7.6-14 years). Main Outcome Measures Discrimination of CVD outcomes and reclassification of participants across predicted 10-year risk categories of low (<10%), intermediate (10%-<20%), and high (>= 20%) risk. Results The addition of information on various lipid-related markers to total cholesterol, HDL-C, and other conventional risk factors yielded improvement in the model's discrimination: C-index change, 0.0006 (95% CI, 0.0002-0.0009) for the combination of apolipoprotein B and A-I; 0.0016 (95% CI, 0.0009-0.0023) for lipoprotein(a); and 0.0018 (95% CI, 0.0010-0.0026) for lipoprotein-associated phospholipase A(2) mass. Net reclassification improvements were less than 1% with the addition of each of these markers to risk scores containing conventional risk factors. We estimated that for 100 000 adults aged 40 years or older, 15 436 would be initially classified at intermediate risk using conventional risk factors alone. Additional testing with a combination of apolipoprotein B and A-I would reclassify 1.1%; lipoprotein(a), 4.1%; and lipoprotein-associated phospholipase A(2) mass, 2.7% of people to a 20% or higher predicted CVD risk category and, therefore, in need of statin treatment under Adult Treatment Panel III guidelines. Conclusion In a study of individuals without known CVD, the addition of information on the combination of apolipoprotein B and A-I, lipoprotein(a), or lipoprotein-associated phospholipase A(2) mass to risk scores containing total cholesterol and HDL-C led to slight improvement in CVD prediction. JAMA. 2012; 307(23):2499-2506 www.jama.com
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