Slight improvement in cardiovascular disease prediction with apolipoproteins, lipoproteins
TUESDAY, June 19 (HealthDay News) -- The addition of certain apolipoproteins and lipoproteins to cardiovascular disease (CVD) risk scores containing total cholesterol and high-density lipoprotein cholesterol (HDL-C) slightly improves CVD risk prediction, according to a study published in the June 20 issue of the Journal of the American Medical Association.
Emanuele Di Angelantonio, M.D., from the University of Cambridge in the United Kingdom, and colleagues reviewed data from 37 prospective cohorts involving 165,544 participants, all without baseline CVD.
During a median of 10.4 years of follow-up the researchers found that there were up to 15,126 incident CVD outcomes. The addition of various lipid-related markers to total cholesterol, HDL-C, and conventional risk factors resulted in improved discrimination, with a C-index change of 0.0006 for the combination of apolipoprotein B and A-I; 0.0016 for lipoprotein(a); and 0.0018 for lipoprotein-associated phospholipase A2 mass. The addition of each of these markers to risk scores containing conventional risk factors resulted in net reclassification improvements of less than 1 percent. For adults aged 40 years or older, using conventional risk factors alone, 15,436 of 100,000 would be initially classified at intermediate risk. Using additional testing, 1.1 percent would be reclassified with a combination of apolipoprotein B and A-I; 4.1 percent with lipoprotein(a); and 2.7 percent with lipoprotein-associated phospholipase A2 mass to a 20 percent or higher predicted CVD risk category, which would necessitate statin treatment under Adult Treatment Panel III guidelines.
"The clinical benefits of using any of these biomarkers remains to be established," the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.