Simpler Cardiovascular Risk Prediction in Women Suggested

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Simpler Cardiovascular Risk Prediction in Women Suggested

By Peggy Peck, Senior Editor, MedPage Today

Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of

Pennsylvania School of Medicine.

July 20, 2005

Review

BOSTON, July 20-Predicting cardiovascular risk in women is best done

using simple measures such as non-HDL-cholesterol or LDL-C to total

cholesterol ratios, rather than complex apolipoprotein evaluations or

high sensitivity C-reactive protein (CRP), say researchers here.

When evaluating healthy, middle-age women those simple tests are as

good as more expensive assays for apolipoproteins B100 and A-1, and

superior to use of total cholesterol or LDL-cholesterol alone, said

M. Ridker, M.D., of the Center for Cardiovascular Disease

Management.

In a study reported in the Journal of the American Medical Association,

Dr. Ridker and colleagues compared non-HDL-C, apolipoproteins B100 and

A-1, standard lipid measures, and high sensitivity C-reactive protein

(CRP) as predictors of risk in 15,632 women enrolled in the Women's

Health Study.

The women, who were 45 or older at enrollment in 1992-1995, were

followed for more than 10 years for cardiovascular events. During

follow-up 464 first ever cardiovascular events were reported.

After adjusting for age, smoking status, blood pressure, diabetes and

body mass index, women who had the highest serum concentrations of

apolipoprotein B100 were 2.5 times more likely to have a cardiovascular

event than women with low levels of apolipoprotein B. But that was

roughly the same relative risk as women with the highest non-HDL-C

levels.

The strength of the association between these two biomarkers is so

strong that they are clinically equivalent, which means, according to

Dr. Ridker, that non-HDL-C is the preferred measure since it " can be

directly calculated by subtracting HDL-C from total cholesterol at no

incremental cost beyond usual lipid evaluation.

Likewise, while the ratio of apolipoprotein B100 to apolipoprotein A-1

is strongly associated with cardiovascular risk, it was not superior to

the ratio of total cholesterol to HDL-C.

Thus, it is not " clinically important to replace standard lipid

measures with more complex apolipoprotein evaluations -- at least for

the purpose of primary risk detection, " Dr. Ridker wrote.

Moreover, he said that use of a ratio, be it total cholesterol to HDL-C

or LDL-C to HDL-C is " superior to the use of total cholesterol or LDL-C

alone, " a finding that contradicts the recent recommendation from the

European Systemic Coronary Risk Evaluation (SCORE) project, which

advocates the use of stand alone total cholesterol values.

As for CRP, a test that is a pet project for Dr. Ridker who developed

and holds the patent for the high sensitivity CRP assay, the hazard

ratio for those in the top versus bottom quintile of high sensitivity

CRP was 2.98 (95% CI 1.90-4.67), which was higher than either non-HDL-c

or apolipoprotein B100, but CRP did not correlate well with other lipid

values.

Thus, the data with regard to CRP suggest that it is not a suitable

substitute for standard lipid values when calculating cardiovascular

risk in women.

However, the authors pointed out that there was virtually no use of

statin therapy in the cohort enrolled in this study and that " these

data should not be construed to exclude a potential role for

apolipoprotein B100 or the ratio of apolipoprotein B100 to

apolipoprotein A-I in monitoring patients taking statins. "

They also indicated that " recent data suggest potential utility for

this inflammatory biomarker as an adjunctive method to monitor statin

efficacy not as a replacement for LDL-C. The possible role of combined

apolipoprotein and high-sensitivity CRP evaluation to monitor patients

taking statins needs to be evaluated. "

http://www.medpagetoday.com/Cardiology/Cholesterol/tb1/1390