Sex-Related Differences of the Effect of Lipoproteins and Apolipoproteins on 10-Year Cardiovascular Disease Risk; Insights from the ATTICA Study (2002–2012)

Abstract

The sex-specific effect of lipid-related biomarkers on 10-year first fatal/non fatal cardiovascular disease (CVD) incidence was evaluated. ATTICA study was conducted during 2001–2012. n = 1514 men and n = 1528 women (>18 years) from greater Athens area, Greece were recruited. Follow-up (2011–2012) was achieved in n = 2020 participants. Baseline lipid profile was measured. Overall CVD event was 15.5% (n = 317) (19.7% in men and 11.7% in women, p < 0.001). High density lipoprotein cholesterol (HDL-C) and triglycerides (TAG) were independently associated with CVD in women; per 10 mg/dL HDL-C increase, hazard ratio (HR) = 0.73, 95% confidence interval (95% CI) (0.53, 1.00); and per 10 mg/dL TAG increase, HR = 1.10, 95% CI (1.00, 1.21). Apolipoprotein A1 (ApoA1) (per 10 mg/dL increase, HR = 0.90, 95% CI (0.81, 0.99)) was inversely associated with CVD in women, while a positive association with apolipoprotein B100 (ApoB100) was observed only in men (per 10 mg/dL increase, HR = 1.10, 95% CI (1.00, 1.21)). Non-HDL-C was associated with CVD in the total sample (HR = 1.10, 95% CI (1.00, 1.21)) and in women (HR = 1.10, 95% CI (1.00, 1.21)); a steep increase in HR was observed for values >185 mg/dL in the total sample and in men, while in women, a raise in CVD risk was observed from lower values (>145 mg/dL). As for non-HDL-C/HDL-C and TC/HDL-C ratios, similar trends were observed. Beyond the common cholesterol-adjusted risk scores, reclassifying total CVD risk according to other lipid markers may contribute to early CVD prevention. Biomarkers such as HDL-C, non-HDL-C, and TAG should be more closely monitored in women.

Non-HDL-C/HDL-C ratio is associated with carotid plaque stability in general population: A cross-sectional study

“…A multicenter study ( 22 ) found that postmenopausal women with higher non-HDL-C/HDL-C ratios had a greater chance of developing carotid atherosclerotic plaque ( OR : 1.30, 95% CI : 1.07–1.58, p = 0.009) when adjusted for other cardiovascular risk factors. Recently, studies found that the non-HDL-C/HDL-C ratio might be a more accurate predictor of cardiovascular disease ( 26 , 27 ). In addition, an asymptomatic polyvascular abnormalities in Community study ( 37 ) found that the odds of unstable carotid plaques at non-HDL-C levels in the middle and highest trilaterals were 1.02 (95% CI , 0.84–1.23) and 1.50 (95% CI , 1.23–1.82), respectively, after adjusting for confounders.…”

“…The thicker the lipid core, the more likely it is to cause expansion of the necrotic core of the plaque, resulting in plaque rupture ( 25 ). Moreover, recently studies showed that the non-HDL-C/HDL-C ratio might be a better predictor of cardiovascular events than traditional lipid indices ( 26 , 27 ). However, to date, there is no data on evaluating the association between non-HDL-C/HDL-C ratio and carotid plaque stability.…”

The Predictive Value of Atherogenic Index of Plasma, Non- High Density Lipoprotein Cholesterol (Non-HDL-C), Non-HDL-C/HDL-C, and Lipoprotein Combine Index for Stroke Incidence and Prognosis in Maintenance Hemodialysis Patients

“…The non-HDL-C/HDL-C ratio, which represents the ratio of atherogenic factors to anti-atherogenic factors, has been shown to correlate with various dyslipidemia-related diseases, including diabetes mellitus and metabolic syndrome. 41 , 42 Studies have shown that it may be a more accurate predictor of cardiovascular disease than the traditional lipid index, 43 and high non-HDL-C/HDL-C ratios are strongly associated with poorer overall survival in peritoneal dialysis patients. 44 In addition, an independent association has been found with carotid plaque lipid cores.…”

Cumulative non-high-density lipoprotein cholesterol burden and risk of atherosclerotic cardiovascular disease: a prospective community-based study

“…First, some unmeasured confounders such as dietary fatty acids and carbohydrates ( 23 ), oils and solid fats ( 24 ) and some diseases include hepatitis ( 25 ) and nephrotic syndrome may have effects on the association of non-HDL-C and ASCVD. Second, Our study has unbalanced distributions of gender while the sex-specific effect of lipid-related biomarkers has been evaluated ( 26 ). Third, the sample was predominantly Chinese, and thus this finding may not be consistent in other racial groups.…”