Coronary heart disease prediction from lipoprotein cholesterol levels, triglycerides, lipoprotein(a), apolipoproteins A-I and B, and HDL density subfractions - The Atherosclerosis Risk in Communities (ARIC) Study

Background-Despite consensus on the need for blood cholesterol reductions t o prevent coronary heart disease (CHD), available evidence on optimal chole sterol levels or the added predictive value of additional lipids is sparse. Methods and Results-After 10 years follow-up of 12 339 middle-aged particip ants free of CHD in the Atherosclerosis Risk in Communities Study (ARIC), 7 25 CHD events occurred. The lowest incidence was observed in those at the l owest LDL cholesterol (LDL-C) quintile, with medians of 88 mg/dL in women a nd 95 mg/dL in men, and risk accelerated at higher levels, with relative ri sks (RRs) for the highest quintile of 2.7 in women and 2.5 in men. LDL-C, H DL-C, lipoprotein(a) [Lp(a)], and in women but not men, triglycerides (TG) were all independent CHD predictors, providing an RR, together with blood p ressure, smoking, and diabetes, of 13.5 in women and 4.9 in men. Lp(a) was less significant in blacks than whites. Prediction was not enhanced by HDL- C density subfractions or apolipoproteins (apo) A-I or B. Despite strong un ivariate associations, apoB did not contribute to risk prediction in subgro ups with elevated TG, with lower LDL-C, or with high apoB relative to LDL-C . Conclusions-Optimal LDL-C values are <100 mg/dL in both women and men. LDL- C, HDL-C, TG, and Lp(a), without additional apolipoproteins or lipid subfra ctions, provide substantial CHD prediction, with much higher RR in women th an men.