What is the clinical evidence from this study?

Study design: Cohort. Population: Coronary Heart Disease (n=8132). Intervention: Non-HDL-cholesterol levels (140-159 mg/dL) vs. Non-HDL-cholesterol <100 mg/dL. Primary outcome: Incidence of Coronary Heart Disease (CHD) (HR 2.49, 95% CI 1.35-4.61).

January 1, 2011Open Access

Association between Non-High-Density Lipoprotein Cholesterol Levels and the Incidence of Coronary Heart Disease among Japanese: The Circulatory Risk in Communities Study (CIRCS)

Q: What are the key findings of this study?

Non-HDL-cholesterol levels of 140-159 mg/dL were associated with a significantly increased risk of coronary heart disease (HR 2.49) compared to levels <100 mg/dL in a Japanese general population.

Resultado clave

Non-HDL-cholesterol levels of 140-159 mg/dL were associated with a significantly increased risk of coronary heart disease (HR 2.49) compared to levels <100 mg/dL in a Japanese general population.

Diseño del estudio

Tipo

Cohort (n=8,132)

Multicéntrico

Sí

PICO estructurado

Do higher non-HDL-cholesterol levels increase the incidence of coronary heart disease in a healthy Japanese general population?

Población

8,132 Japanese men and women aged 40 to 69 years with no history of stroke or coronary heart disease, followed for a median of 21.9 years.

Exposición

Higher non-HDL-cholesterol levels (specifically evaluated at thresholds such as ≥140 mg/dL)

Comparador

Lower non-HDL-cholesterol levels (specifically <100 mg/dL used as the reference category)

Resultado

Incidence of coronary heart disease (composite of definite or probable myocardial infarction, angina pectoris, and sudden cardiac death) at a median follow-up of 21.9 yearshard clinical

In a Japanese general population, non-HDL-cholesterol levels ≥140 mg/dL are associated with a significantly increased risk of incident coronary heart disease over a 22-year follow-up.

Resultado numérico

Hazard Ratio: 2.49 (95% CI 1.35–4.61)

Limitaciones

Relatively small number of incident cases leading to wide confidence intervals
Observational design identifies a cut-off point for prediction but does not confirm the beneficial effects of lowering non-HDL-cholesterol below it
Did not compare the predictive ability for CHD incidence between non-HDL-cholesterol and other lipid measurements

Resumen

AIM: The aim of this study was to identify the threshold level for non-high-density lipoprotein cholesterol (non-HDL-cholesterol) to raise the risk of coronary heart disease (CHD) incidence in a Japanese general population. METHODS: A total of 8,132 men and women, aged 40 to 69 years with no history of stroke or CHD, completed the baseline risk factor surveys between 1975 and 1987. Systematic surveillance of cardiovascular disease incidence was performed through 2003 (the median follow-up period was 21.9 years), and 155 incidents of CHD were identified. RESULTS: We found a statistically significant association between non-HDL-cholesterol levels and the risk of CHD with a threshold around 140 mg/dL. After adjustment for potential confounding factors, this association did not change materially. The multivariable hazard ratio of CHD compared with that for levels of < 100 mg/dL was 2.49 (95% confidence interval: 1.35 to 4.61) for 140-159 mg/dL and 3.13 (1.58-6.21) for ≥ 180 mg/dL. Setting the cut-off point at ≥ 140 mg/dL non-HDL-cholesterol resulted in the greatest improvement of integrated discrimination. CONCLUSIONS: Higher concentrations of non-HDL-cholesterol are associated with an increased risk of CHD with a threshold around 140 mg/dL, suggesting that the optimal cut-off point for healthy per-sons to prevent increasing the risk of CHD might be around 140 mg/dL non-HDL-cholesterol.

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