Abstract Background and aims Little is known about the importance of blood lipids for risk of myocardial infarction (MI) in Chinese vs European populations. We compared the associations with MI of apolioprotein B (ApoB) vs low-density lipoprotein cholesterol (LDL-C) and remnant-cholesterol (remnant-C) vs triglycerides in the China Kadoorie Biobank (CKB) and UK Biobank (UKB). Methods Plasma levels of LDL-C, high-density lipoprotein-cholesterol (HDL-C), apolipoprotein B (ApoB), apolipoprotein A1 (ApoA1), non-HDL-C, remnant-C, LDL-C/ApoB and HDL-C/ApoA1 ratios were measured in a nested case-control study of MI (948 cases, 6,101 controls) in CKB and a prospective study (5,344 cases in 279,989 participants) in UKB. Associations of lipids with MI were assessed using logistic regression in CKB and Cox regression in UKB after adjustment for confounders and correction for regression dilution. Results The mean levels of LDL-C were about 30% lower in CKB than in UKB (2.3 0.6 vs 3.7 0.8 mmol/L), but mean levels of HDL were comparable (1.3 0.3 vs 1.5 0.4 mmol/L), as were those for triglycerides (1.8 1.1 vs 1.7 [1.1 mmol/L). While, the rate ratios (RR) of MI for 1 SD higher usual levels of LDL-C in Chinese were about half those in Europeans (1.27; 1.13-1.44 vs 1.55; 1.49-1.61), the corresponding RRs for ApoB or non-HDL with MI were comparable between Chinese and Europeans. Conclusions The findings reinforce current guidelines for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in China that advocate initiation of statin treatment in individuals at high-risk of ASCVD rather than high levels of LDL-C.
Hanyu et al. (Thu,) studied this question.
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