Trajectories of Blood Lipid Concentrations Over the Adult Life Course and Risk of Cardiovascular Disease and All‐Cause Mortality: Observations From the Framingham Study Over 35 Years

Background Elevated total cholesterol ( TC ), low-density lipoprotein cholesterol ( LDL -C), triglycerides, and non-high-density lipoprotein cholesterol (non- HDL -C) and low high-density lipoprotein cholesterol ( HDL -C) concentrations correlate with atherosclerotic cardiovascular disease ( ASCVD )...

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Vydané v:Journal of the American Heart Association Ročník 8; číslo 11; s. e011433
Hlavní autori: Duncan, Meredith S., Vasan, Ramachandran S., Xanthakis, Vanessa
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: England John Wiley and Sons Inc 04.06.2019
Wiley
Predmet:
Adult
Aged
Atherosclerosis - blood
Atherosclerosis - diagnosis
Atherosclerosis - mortality
Biomarkers - blood
cardiovascular disease
Cause of Death
Cholesterol, HDL - blood
Cholesterol, LDL - blood
Dyslipidemias - blood
Dyslipidemias - diagnosis
Dyslipidemias - mortality
Female
Humans
Incidence
life‐course
lipids
Lipids - blood
longitudinal
Longitudinal Studies
Male
Massachusetts - epidemiology
Middle Aged
Original Research
Prognosis
Prospective Studies
Risk Assessment
Risk Factors
Time Factors
trajectories
Triglycerides - blood
Massachusetts
cardiovascular disease
lipids
life‐course
longitudinal
trajectories
ISSN:2047-9980, 2047-9980
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Shrnutí:Background Elevated total cholesterol ( TC ), low-density lipoprotein cholesterol ( LDL -C), triglycerides, and non-high-density lipoprotein cholesterol (non- HDL -C) and low high-density lipoprotein cholesterol ( HDL -C) concentrations correlate with atherosclerotic cardiovascular disease ( ASCVD ) and mortality. Therefore, understanding how lipid trajectories throughout adulthood impact ASCVD and mortality risk is essential. Methods and Results We investigated 3875 Framingham Offspring participants (54% women, mean age 48 years) attending ≥1 examination between 1979 and 2014. We evaluated longitudinal correlates of each lipid subtype using mixed-effects models. Next, we clustered individuals into trajectories through group-based modeling. Thereafter, we assessed the prospective association of lipid trajectories with ASCVD and mortality. Male sex, greater body mass index, and smoking correlated with higher TC , LDL -C, triglycerides, non- HDL -C, and lower HDL -C concentrations. We identified 5 TC , HDL -C, and LDL -C trajectories, and 4 triglycerides and non- HDL -C trajectories. Upon follow-up (median 8.2 years; 199 ASCVD events; 256 deaths), elevated TC (>240 mg/ dL ), LDL -C (>155 mg/ dL ), or non- HDL -C (>180 mg/ dL ) concentrations conferred >2.25-fold ASCVD and mortality risk compared with concentrations <165 mg/ dL , <90 mg/ dL , and <115 mg/ dL , respectively ([ TC hazard ratio ( HR ) =4.17, 95% CI 1.94-8.99; TC HR =2.47, 95% CI 1.28-4.76] [ LDL -C HR =5.09, 95% CI 1.54-16.85; LDL -C HR =4.04, 95% CI 1.84-8.89] [non- HDL -C HR =4.60, 95% CI 1.98-10.70; LDL -C HR =3.74, 95% CI 2.03-6.88]). Consistent HDL -C concentrations <40 mg/ dL were associated with greater ASCVD and mortality risk than concentrations >70 mg/ dL (HR =3.81, 95% CI 2.04-7.15; HR =2.88, 95% CI 1.70-4.89). Triglycerides trajectories were unassociated with outcomes. Conclusions Using a longitudinal modeling technique, we demonstrated that unfavorable lipid trajectories over 35 years confer higher ASCVD and mortality risk later in life.
Bibliografia:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:2047-9980
2047-9980
DOI:10.1161/JAHA.118.011433