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. 2006 Nov;98(11):1740–1745.

Multiple lipid scoring system for prediction of coronary heart disease risk: application to African Americans.

Charles J Everett 1, Arch G Mainous 3rd 1, Richelle J Koopman 1, Vanessa A Diaz 1
PMCID: PMC2569773  PMID: 17128681

Abstract

BACKGROUND: Clinicians often obtain a panel of lipids but then only use low-density-lipoprotein (LDL) cholesterol to make clinical decisions. We previously described the multiple lipid measure, a strategy that integrates information about seven lipid measures. Our current inquiry uses the multiple lipid measure to create a scoring system and validates that system in a second cohort. METHODS AND RESULTS: A scoring system that uses total cholesterol, high-density lipoprotein (HDL) cholesterol, LDL cholesterol and triglycerides was developed and tested. African-American participants of the Atherosclerosis Risk in Communities (ARIC) Study were used to validate the multiple lipid measure score. For nonsmokers, scores > or = 2 had a hazard ratio of 4.25 (95% CI 1.92-9.40) compared to reference scores of < or = -3 in adjusted survival analysis predicting incident coronary heart disease risk in the ARIC. The best conventional single lipid measure for nonsmokers was LDL cholesterol. Compared to LDL cholesterol <100 mg/dl, those with LDL cholesterol > or = 160 mg/dl had a hazard ratio of 2.31 (95% CI 1.13-4.75). For current smokers, the best conventional lipid measure was the total cholesterol/HDL cholesterol ratio, which was similar in predictive ability to the multiple lipid measure score. However, the multiple lipid measure score predicted an additional 10% of the cohort at risk compared to the total cholesterol/HDL cholesterol ratio. CONCLUSIONS: The use of the multiple lipid scoring system improves the assessment of incident coronary heart disease risk and may have utility for clinicians in integrating lipid values.

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Selected References

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  1. Brown S. A., Epps D. F., Dunn J. K., Sharrett A. R., Patsch J. R., Gotto A. M., Jr, Patsch W. Effect of blood collection and processing on radioimmunoassay results for apolipoprotein B in plasma. Clin Chem. 1990 Sep;36(9):1662–1666. [PubMed] [Google Scholar]
  2. Brown S. A., Hutchinson R., Morrisett J., Boerwinkle E., Davis C. E., Gotto A. M., Jr, Patsch W. Plasma lipid, lipoprotein cholesterol, and apoprotein distributions in selected US communities. The Atherosclerosis Risk in Communities (ARIC) Study. Arterioscler Thromb. 1993 Aug;13(8):1139–1158. doi: 10.1161/01.atv.13.8.1139. [DOI] [PubMed] [Google Scholar]
  3. Contois J. H., McNamara J. R., Lammi-Keefe C. J., Wilson P. W., Massov T., Schaefer E. J. Reference intervals for plasma apolipoprotein B determined with a standardized commercial immunoturbidimetric assay: results from the Framingham Offspring Study. Clin Chem. 1996 Apr;42(4):515–523. [PubMed] [Google Scholar]
  4. Contois J., McNamara J. R., Lammi-Keefe C., Wilson P. W., Massov T., Schaefer E. J. Reference intervals for plasma apolipoprotein A-1 determined with a standardized commercial immunoturbidimetric assay: results from the Framingham Offspring Study. Clin Chem. 1996 Apr;42(4):507–514. [PubMed] [Google Scholar]
  5. Everett Charles J., Mainous Arch G., 3rd, Koopman Richelle J., Diaz Vanessa A. Predicting coronary heart disease risk using multiple lipid measures. Am J Cardiol. 2005 Apr 15;95(8):986–988. doi: 10.1016/j.amjcard.2004.12.043. [DOI] [PubMed] [Google Scholar]
  6. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001 May 16;285(19):2486–2497. doi: 10.1001/jama.285.19.2486. [DOI] [PubMed] [Google Scholar]
  7. Friedewald W. T., Levy R. I., Fredrickson D. S. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972 Jun;18(6):499–502. [PubMed] [Google Scholar]
  8. Gotto A. M., Jr, Whitney E., Stein E. A., Shapiro D. R., Clearfield M., Weis S., Jou J. Y., Langendörfer A., Beere P. A., Watson D. J. Relation between baseline and on-treatment lipid parameters and first acute major coronary events in the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS). Circulation. 2000 Feb 8;101(5):477–484. doi: 10.1161/01.cir.101.5.477. [DOI] [PubMed] [Google Scholar]
  9. Kshirsagar Abhijit V., Carpenter Myra, Bang Heejung, Wyatt Sharon B., Colindres Romulo E. Blood pressure usually considered normal is associated with an elevated risk of cardiovascular disease. Am J Med. 2006 Feb;119(2):133–141. doi: 10.1016/j.amjmed.2005.08.023. [DOI] [PubMed] [Google Scholar]
  10. Lamarche B., Moorjani S., Lupien P. J., Cantin B., Bernard P. M., Dagenais G. R., Després J. P. Apolipoprotein A-I and B levels and the risk of ischemic heart disease during a five-year follow-up of men in the Québec cardiovascular study. Circulation. 1996 Aug 1;94(3):273–278. doi: 10.1161/01.cir.94.3.273. [DOI] [PubMed] [Google Scholar]
  11. Moss A. J., Goldstein R. E., Marder V. J., Sparks C. E., Oakes D., Greenberg H., Weiss H. J., Zareba W., Brown M. W., Liang C. S. Thrombogenic factors and recurrent coronary events. Circulation. 1999 May 18;99(19):2517–2522. doi: 10.1161/01.cir.99.19.2517. [DOI] [PubMed] [Google Scholar]
  12. Nägele U., Hägele E. O., Sauer G., Wiedemann E., Lehmann P., Wahlefeld A. W., Gruber W. Reagent for the enzymatic determination of serum total triglycerides with improved lipolytic efficiency. J Clin Chem Clin Biochem. 1984 Feb;22(2):165–174. doi: 10.1515/cclm.1984.22.2.165. [DOI] [PubMed] [Google Scholar]
  13. Nägele U., Hägele E. O., Sauer G., Wiedemann E., Lehmann P., Wahlefeld A. W., Gruber W. Reagent for the enzymatic determination of serum total triglycerides with improved lipolytic efficiency. J Clin Chem Clin Biochem. 1984 Feb;22(2):165–174. doi: 10.1515/cclm.1984.22.2.165. [DOI] [PubMed] [Google Scholar]
  14. Schaefer E. J., Lamon-Fava S., Ordovas J. M., Cohn S. D., Schaefer M. M., Castelli W. P., Wilson P. W. Factors associated with low and elevated plasma high density lipoprotein cholesterol and apolipoprotein A-I levels in the Framingham Offspring Study. J Lipid Res. 1994 May;35(5):871–882. [PubMed] [Google Scholar]
  15. Schonfeld G., Lees R. S., George P. K., Pfleger B. Assay of total plasma apolipoprotein B concentration in human subjects. J Clin Invest. 1974 May;53(5):1458–1467. doi: 10.1172/JCI107694. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Shai Iris, Rimm Eric B., Hankinson Susan E., Curhan Gary, Manson JoAnn E., Rifai Nader, Stampfer Meir J., Ma Jing. Multivariate assessment of lipid parameters as predictors of coronary heart disease among postmenopausal women: potential implications for clinical guidelines. Circulation. 2004 Oct 18;110(18):2824–2830. doi: 10.1161/01.CIR.0000146339.57154.9B. [DOI] [PubMed] [Google Scholar]
  17. Sharrett A. R., Ballantyne C. M., Coady S. A., Heiss G., Sorlie P. D., Catellier D., Patsch W., Atherosclerosis Risk in Communities Study Group Coronary heart disease prediction from lipoprotein cholesterol levels, triglycerides, lipoprotein(a), apolipoproteins A-I and B, and HDL density subfractions: The Atherosclerosis Risk in Communities (ARIC) Study. Circulation. 2001 Sep 4;104(10):1108–1113. doi: 10.1161/hc3501.095214. [DOI] [PubMed] [Google Scholar]
  18. Siedel J., Hägele E. O., Ziegenhorn J., Wahlefeld A. W. Reagent for the enzymatic determination of serum total cholesterol with improved lipolytic efficiency. Clin Chem. 1983 Jun;29(6):1075–1080. [PubMed] [Google Scholar]
  19. Sniderman A. D., Furberg C. D., Keech A., Roeters van Lennep J. E., Frohlich J., Jungner I., Walldius G. Apolipoproteins versus lipids as indices of coronary risk and as targets for statin treatment. Lancet. 2003 Mar 1;361(9359):777–780. doi: 10.1016/s0140-6736(03)12663-3. [DOI] [PubMed] [Google Scholar]
  20. Sniderman Allan D., St-Pierre Annie C., Cantin Bernard, Dagenais Gilles R., Després Jean-Pierre, Lamarche Benoît. Concordance/discordance between plasma apolipoprotein B levels and the cholesterol indexes of atherosclerotic risk. Am J Cardiol. 2003 May 15;91(10):1173–1177. doi: 10.1016/s0002-9149(03)00262-5. [DOI] [PubMed] [Google Scholar]
  21. Talmud Philippa J., Hawe Emma, Miller George J., Humphries Steve E. Nonfasting apolipoprotein B and triglyceride levels as a useful predictor of coronary heart disease risk in middle-aged UK men. Arterioscler Thromb Vasc Biol. 2002 Nov 1;22(11):1918–1923. doi: 10.1161/01.atv.0000035521.22199.c7. [DOI] [PubMed] [Google Scholar]
  22. Walldius G., Jungner I., Holme I., Aastveit A. H., Kolar W., Steiner E. High apolipoprotein B, low apolipoprotein A-I, and improvement in the prediction of fatal myocardial infarction (AMORIS study): a prospective study. Lancet. 2001 Dec 15;358(9298):2026–2033. doi: 10.1016/S0140-6736(01)07098-2. [DOI] [PubMed] [Google Scholar]
  23. Warnick G. R., Benderson J., Albers J. J. Dextran sulfate-Mg2+ precipitation procedure for quantitation of high-density-lipoprotein cholesterol. Clin Chem. 1982 Jun;28(6):1379–1388. [PubMed] [Google Scholar]

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