While the measurement and management of cholesterol forms an integral part of cardiovascular risk management, it has been suggested that risk assessment could be improved by the assessment of various additional lipid-related markers either to supplement or replace traditional cholesterol measurements. The aim of this paper was to determine whether cardiovascular risk prediction could be improved by adding information on other lipid-related markers, including: apolipoprotein B and apolipoprotein A-I, lipoprotein(a), or lipoprotein-associated phospholipase A2.
The study examined individual records from 165,544 participants – all of whom were free of cardiovascular disease at baseline – who took part in 37 prospective trials between 1968 and 2007. 15,126 incident fatal or non-fatal cardiovascular outcomes occurred during a median follow-up of 10.4 years. The main outcome measures were the ability of the lipid-related markers to discriminate cardiovascular outcomes, and to reclassify participants across predicted 10-year risk categories (low, <10%; intermediate, 10-<20%, and high ≥20%).
The authors estimated that for 100,000 adults aged 40 years or older, 15,436 would be initially classified at intermediate risk using conventional risk factors alone. However, additional testing with a combination of apolipoprotein B and A-I would reclassify 1.1%; the use of lipoprotein(a), 4.1%; and the use of lipoprotein-associated phospholipase A2 mass, 2.7% of these people to a 20% or higher predicted CVD risk category. This is clinically significant as under Adult Treatment Panel III guidelines statin therapy is recommended for patients in the higher predicted risk category.
Although the improvement was small, the addition of information on the combination of apolipoprotein B and A-I, lipoprotein(a), or lipoprotein- associated phospholipase A2 mass to risk scores containing total cholesterol and HDL-C led to a slight improvement in CVD prediction in this population of patients without known cardiovascular disease.
- The Emerging Risk Factors Collaboration. Lipid-Related Markers and Cardiovascular Disease Predicition. JAMA 2012; 307:249-2506.