Preventive Cardiology
Usefulness of Non–High-Density Lipoprotein Cholesterol as a Predictor of Cardiovascular Disease Mortality in Men in 22-Year Follow-Up

https://doi.org/10.1016/j.amjcard.2017.01.008Get rights and content

Non–high-density lipoprotein cholesterol (non-HDL-C) may be equivalent or superior to low-density lipoprotein cholesterol (LDL-C) for prediction of cardiovascular disease (CVD) risk. However, studies comparing the predictive values of LDL-C and non-HDL-C for CVD and total mortality in a long-term follow-up yielded conflicting results. The Cardiovascular Occupational Risk Factor Determination in Israel Study (CORDIS) is a prospective cohort study of a young industrial population of workers with a long-term follow-up. The initial phase of the study was carried out in 1985–1999. Interviews and physical examinations were conducted, and fasting blood samples, including lipid panels, were undertaken. In 2007, after a 22-year follow-up period, the baseline data were merged with data on all-cause and CVD mortality obtained from the Israeli National Death Registry. A total of 4,832 men were included in the analysis with a mean age of 42.1 ± 12.1 years. Univariate analysis indicated a positive association between non-HDL-C and LDL-C levels and an increased risk for both all-cause and CVD mortality. Multiple regression analysis, following adjustment for potential confounders, resulted in attenuation of the association of both lipoproteins with total mortality. The adjusted association between non-HDL-C levels ≥190 mg/dl and CVD mortality remained significant (hazard ratio 1.80, 95% confidence interval 1.10 to 2.96), but the association of LDL-C with CVD mortality was attenuated (hazard ratio 1.53, 95% confidence interval 0.98 to 2.39). In conclusion, non-HDL-C may be a more potent predictor of CVD mortality than LDL-C levels.

Section snippets

Methods

The Cardiovascular Occupational Risk Factor Determination in Israel Study (CORDIS) cohort included male workers recruited from 21 industrial plants (metal work, textiles, light industry, electronics, food manufacturing, and plywood production) throughout Israel for on-site screening of cardiovascular risk factors. The current analysis was restricted to a working population of Jewish men aged 20 to 70 years at baseline. Arab men (n = 357) were excluded from the current analysis because of

Results

The baseline characteristics of the study participants are presented in Table 1. A total of 4,832 men were included in the analysis with a mean age of 42.1 ± 12.1 years. The mean follow-up time was 22.1 ± 3.2 years (median 22 years). One man with an unknown mortality date and 22 men with missing non-HDL-C tests were excluded from the study. Most workers did not report any history of hypertension (90%), diabetes (96.7%), or family history of MI (76%).

Non-HDL-C levels were positively associated

Discussion

In this male prospective cohort study, higher levels of non-HDL-C at baseline were associated with a significantly increased risk of CVD mortality, independently of a wide range of potential confounders, including lifestyle parameters, socioeconomic status, education, and medical history. Furthermore, non-HDL-C appeared to be a stronger predictor of CVD and all-cause mortality than LDL-C, which is the main treatment goal according to National Cholesterol Education Program guidelines.3

Disclosures

The authors have no conflicts of interest to disclose.

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