Addition of Lipid-related Markers Results in Slight Improvement in CVD Risk Prediction

The addition of various lipid-related markers to risk scores containing total and high-density lipoprotein (HDL) cholesterol is associated with a slight improvement in cardiovascular disease (CVD) prediction among individuals without known CVD, suggest study findings.

“Routinely used risk prediction scores for CVD contain information on total cholesterol and HDL cholesterol and several other conventional risk factors,” explain the authors in JAMA.

“There is considerable interest in whether CVD prediction can be improved by assessment of various additional lipid-related markers either to replace, or supplement, traditional cholesterol measurements in these scores.”

To investigate further, John Danesh, University of Cambridge, UK, and co-investigators determined whether adding information on apolipoprotein (apo)B and apoA-I, lipoprotein(a), or lipoprotein-associated phospholipase A2 to total and HDL cholesterol improved CVD risk prediction.

They included data from 165,544 individuals free from CVD at baseline in their analysis. During a median follow-up of 10.4 years there were a total of 15,126 incident fatal or nonfatal CVD outcomes (10,132 coronary heart disease; 4,994 stroke).

The researchers found that replacing total and HDL cholesterol with information on various lipid-related markers did not improve risk discrimination or reclassification.

They did find, however, that the addition of information on various lipid-related markers to total and HDL cholesterol yielded improvement in the model’s discrimination.

Indeed, when the researchers modeled 100,000 adults aged 40 years or older they estimated that 15,436 would initially be classified at intermediate risk using conventional risk factors alone. Addition of a combination of apoB and A-I would reclassify 1.1 % of people to a 20 % or higher predicted CVD risk category. Similarly, addition of lipoprotein(a) or lipoprotein-associated phospholipase A2 would reclassify 4.1 % and 2.7 % of people, respectively.

The authors note that individuals reclassified in this way would be in need of statin treatment under the Adult Treatment Panel III guidelines.

However, “the clinical benefits of using any of these biomarkers remains to be established,” concludes the team.

By David W Ramsey