In evaluating patients' vascular risk, lipid assessment can be simplified without sacrificing accuracy, according to researchers in the Emerging Risk Factors Collaboration.
“Expert opinion is divided” about whether measurement of apolipoproteins should replace that of cholesterol, the importance of triglyceride measurements, and the necessity of patients' fasting before physicians obtain these measurements. Now, analysis of data amassed in the Emerging Risk Factors Collaboration [ERFC] shows that these issues are not critically important, said Dr. John Danesh of the University of Cambridge (England) and his associates in the ERFC.
The ERFC pooled data from 112 prospective studies of cardiovascular risk factors involving 1.2 million subjects in 21 countries in western Europe and North America. Subjects' mean age was 59 years at baseline; median follow-up was 6 years.
Cholesterol levels and apolipoprotein levels were found to be equally useful in predicting vascular risk, with nearly identical hazard ratios for the two approaches. “This finding suggests that current discussions about whether to measure cholesterol levels or apolipoproteins … should hinge more on practical considerations … than on major differences in strength of epidemiological associations,” the investigators said.
Moreover, hazard ratios for vascular disease were at least as strong among subjects who did not fast before testing as among those who did. In addition, triglyceride concentration showed no relation with vascular risk independently of cholesterol levels, Dr. Danesh and his colleagues said (JAMA 2009;302:1993-2000).
The ERFC is funded by the British Heart Foundation, the UK Medical Research Council, the BUPA Foundation, and GlaxoSmithKline. Dr. Danesh received funding from the British Heart Foundation; BUPA Foundation; diaDexus; European Union; Evelyn Trust; Fogarty International Center; GlaxoSmithKline; Medical Research Council; Merck Sharp and Dohme; National Heart, Lung, and Blood Institute; National Institute of Neurological Disorders and Stroke; Novartis; Roche; and Wellcome Trust.