@article {781, title = {Lipoprotein lipids in older people. Results from the Cardiovascular Health Study. The CHS Collaborative Research Group.}, journal = {Circulation}, volume = {86}, year = {1992}, month = {1992 Sep}, pages = {858-69}, abstract = {

BACKGROUND: Cardiovascular disease is the leading cause of death and disability in older people. There is little information about the distributions of risk factors in older populations. This article describes the distribution and correlates of lipoprotein lipids in people greater than or equal to 65 years old.

METHODS AND RESULTS: Lipoprotein lipid concentrations were measured in 2,106 men (M) and 2,732 women (F) who were participants in the Cardiovascular Health Study, a population-based epidemiological study. Distributions of lipids by age and sex and bivariate and multivariate relations among lipids and other variables were determined in cross-sectional analyses. Mean concentrations of lipids were cholesterol: M, 5.20 +/- 0.93 mmol/l (201 +/- 36 mg/dl) and F, 5.81 +/- 0.98 mmol/l (225 +/- 38 mg/dl); triglyceride (TG): M, 1.58 +/- 0.85 mmol/l (140 +/- 75 mg/dl) and F, 1.57 +/- 0.78 mmol/l (139 +/- 69 mg/dl); high density lipoprotein cholesterol (HDL-C): M, 1.23 +/- 0.33 mmol/l (48 +/- 16 mg/dl), and F, 1.53 +/- 0.41 mmol/l (59 +/- 16 mg/dl); low density lipoprotein cholesterol (LDL-C): M, 3.27 +/- 0.85 mmol/l (127 +/- 33 mg/dl) and F, 3.57 +/- 0.93 mmol/l (138 +/- 36 mg/dl). The total cholesterol to HDL-C ratios were M, 4.49 +/- 1.29 and F, 4.05 +/- 1.22. TG, total cholesterol, and LDL-C concentrations were lower with increasing age, the last more evident in men than in women. TG concentration was positively associated with obesity (in women), central fat patterning, glucose intolerance, use of beta-blockers (in men), and use of estrogens (in women) and negatively associated with age, renal function, alcohol use, and socioeconomic status. In general, HDL-C had opposite relations with these variables, except that estrogen use was associated with higher HDL-C concentrations. LDL-C concentration was associated with far fewer variables than the other lipids but was negatively associated with age in men and women and positively correlated with obesity and central fat patterning and negatively correlated with renal function and estrogen use in women. There were no differences in total cholesterol and LDL-C concentrations among participants with and without prevalent coronary heart disease and stroke, but TG concentration was higher and HDL-C lower in men with both coronary heart disease and stroke and in women with coronary heart disease.

CONCLUSIONS: Cholesterol and cholesterol/HDL-C ratio were lower and HDL-C higher than previously reported values in older people, suggesting that lipid risk profiles may be improving in older Americans. TG and HDL-C concentrations, and to a lesser extent LDL-C, were associated with potentially important modifiable factors such as obesity, glucose intolerance, renal function, and medication use.

}, keywords = {Aged, Aging, Cardiovascular Diseases, Cardiovascular Physiological Phenomena, Cholesterol, HDL, Cholesterol, LDL, Cross-Sectional Studies, Female, Health Status, Humans, Lipids, Lipoproteins, Male, Multivariate Analysis, Triglycerides}, issn = {0009-7322}, doi = {10.1161/01.cir.86.3.858}, author = {Ettinger, W H and Wahl, P W and Kuller, L H and Bush, T L and Tracy, R P and Manolio, T A and Borhani, N O and Wong, N D and O{\textquoteright}Leary, D H} } @article {1462, title = {Lipoprotein levels in elderly patients with asthma. Cardiovascular Health Study Research Group.}, journal = {J Allergy Clin Immunol}, volume = {98}, year = {1996}, month = {1996 Aug}, pages = {467-9}, keywords = {Aged, Aging, Arteriosclerosis, Asthma, Female, Humans, Lipoproteins, Male, Prospective Studies, Risk Factors, Sex Factors}, issn = {0091-6749}, author = {Enright, P L and Lasser, E C and Ward, B J and Tracy, R P} } @article {1570, title = {Correlates of antithrombin, protein C, protein S, and TFPI in a healthy elderly cohort.}, journal = {Thromb Haemost}, volume = {80}, year = {1998}, month = {1998 Jul}, pages = {134-9}, abstract = {

The majority of fatal acute myocardial infarctions occur in the elderly. Since these events are predominantly thrombotic, we studied the cross-sectional associations of the anticoagulant proteins Antithrombin, Protein C, Protein S. and Tissue Factor Pathway Inhibitor (TFPI) in a subgroup (n = 400) of the Cardiovascular Health Study (a study of healthy men and women > or = 65 years) free of clinical cardiovascular disease (CVD). We did not observe any strong age-associated trends, although Protein C was lower in older women (p < or = 0.001), and TFPI was higher in older men (p < or = 0.01). The inhibitors were highly intercorrelated, and were associated with increased levels of inflammation-sensitive proteins (e.g., fibrinogen. plasminogen), lipids (especially total and LDL-cholesterol), and coagulation factors, such as Factors VIIc, IXc, and Xc. None was associated with the procoagulant markers Prothrombin Fragment F1-2 or Fibrinopeptide A. Only TFPI was associated with subclinical atherosclerosis: ankle-arm index and internal carotid artery stenosis, p trend < or = 0.01; and carotid wall thickness, p trend < or = 0.05. In multivariate analysis the independent predictors of TFPI were levels of fibrinogen; the fibrinolytic marker plasmin-antiplasmin complex; LDL-cholesterol; and carotid wall thickness (R2 for the model = 0.35). In summary, the inhibitors did not appear to increase with age, and were predominantly associated with inflammation markers and lipids. Since markers of thrombin production do increase with age, we hypothesize that an age-related hemostatic imbalance may ensue, with associated increased thrombotic risk. Only TFPI was associated with subclinical CVD, suggesting that it may more closely reflect endothelial damage.

}, keywords = {Aged, Aged, 80 and over, Analysis of Variance, Anticoagulants, Antithrombin III, Biomarkers, Cross-Sectional Studies, Disease Susceptibility, Female, Humans, Lipoproteins, Male, Prevalence, Protein C, Protein S, Reference Values, Risk Factors, Thrombosis}, issn = {0340-6245}, author = {Sakkinen, P A and Cushman, M and Psaty, B M and Kuller, L H and Bajaj, S P and Sabharwal, A K and Boineau, R and Macy, E and Tracy, R P} } @article {672, title = {A regression model for longitudinal change in the presence of measurement error.}, journal = {Ann Epidemiol}, volume = {12}, year = {2002}, month = {2002 Jan}, pages = {34-8}, abstract = {

PURPOSE: The analysis of change in measured variables has become quite popular in studies where data are collected repeatedly over time. The authors describe some of the potential pitfalls in the analysis of change when the variable for change is measured with error. They show that regression analysis is often biased, possibly leading to erroneous results.

METHODS: A simple method to correct for measurement error bias in regression models that model change is presented.

RESULTS AND CONCLUSIONS: The two examples illustrate how measurement error can adversely affect an analysis. The bias-corrected approach yields valid results.

}, keywords = {Aged, Bias, Coronary Disease, Humans, Lipoproteins, Models, Statistical, Regression Analysis, Risk Factors}, issn = {1047-2797}, doi = {10.1016/s1047-2797(01)00280-0}, author = {Yanez, N David and Kronmal, Richard A and Shemanski, Lynn R and Psaty, Bruce M} } @article {872, title = {Lipoprotein subclass and particle size differences in Afro-Caribbeans, African Americans, and white Americans: associations with hepatic lipase gene variation.}, journal = {Metabolism}, volume = {55}, year = {2006}, month = {2006 Jan}, pages = {96-102}, abstract = {

Despite a higher prevalence of coronary heart disease risk factors, men of African origin have less coronary atherosclerosis, as measured by coronary calcification, than whites. In part, this is thought to be because of the less atherogenic lipoprotein profile observed in men of African origin, characterized by lower triglycerides and higher high-density lipoprotein (HDL) cholesterol. We hypothesized that the -514C>T polymorphism in the hepatic lipase gene (LIPC) plays a significant role in determining a less atherogenic lipoprotein profile observed in men of African origin. Previously conducted studies of the LIPC -514C>T polymorphism in African Americans may have been confounded by a higher level of European admixture; in addition, the results from these studies do not necessarily apply to other African populations because gene-environment interactions may differ. Thus, we compared nuclear magnetic resonance spectroscopy-measured lipoprotein subclass patterns and LIPC -514C>T genotypes in population-based samples of older white American (n = 532) and African American (n = 97) men from the Cardiovascular Health Study to those among older, less admixed, Afro-Caribbean men (n = 205) from the Tobago Health Study. Men of African origin had a more favorable lipoprotein profile than whites. In addition, levels of low-density lipoprotein cholesterol, total cholesterol, and triglyceride, and large and small very low-density lipoprotein, small low-density lipoprotein, as well as very low-density lipoprotein particle size, were remarkably lower in Afro-Caribbean men than in either African American or white men. The frequency of the LIPC -514T allele was much higher in Afro-Caribbeans (0.57) and in African Americans (0.49) than in whites (0.20). The -514T allele in both populations of African origin, but not in whites, was associated with elevated large HDL and greater HDL size. Our findings indicate that the higher frequency of the LIPC -514T allele found in men of African origin living in different environments significantly contributes to the more favorable distribution of HDL subclasses compared with whites.

}, keywords = {Adult, African Americans, Age Factors, Aged, Alleles, Body Mass Index, Cardiovascular Diseases, Caribbean Region, Cohort Studies, DNA, European Continental Ancestry Group, Gene Frequency, Genetic Variation, Humans, Lipase, Lipoproteins, Lipoproteins, HDL, Lipoproteins, LDL, Liver, Longitudinal Studies, Male, Middle Aged, Particle Size, Trinidad and Tobago, United States}, issn = {0026-0495}, doi = {10.1016/j.metabol.2005.07.011}, author = {Miljkovic-Gacic, Iva and Bunker, Clareann H and Ferrell, Robert E and Kammerer, Candace M and Evans, Rhobert W and Patrick, Alan L and Kuller, Lewis H} } @article {1399, title = {Lipid-related markers and cardiovascular disease prediction.}, journal = {JAMA}, volume = {307}, year = {2012}, month = {2012 Jun 20}, pages = {2499-506}, abstract = {

CONTEXT: The value of assessing various emerging lipid-related markers for prediction of first cardiovascular events is debated.

OBJECTIVE: To determine whether adding information on apolipoprotein B and apolipoprotein A-I, lipoprotein(a), or lipoprotein-associated phospholipase A2 to total cholesterol and high-density lipoprotein cholesterol (HDL-C) improves cardiovascular disease (CVD) risk prediction.

DESIGN, SETTING, AND PARTICIPANTS: Individual records were available for 165,544 participants without baseline CVD in 37 prospective cohorts (calendar years of recruitment: 1968-2007) with up to 15,126 incident fatal or nonfatal CVD outcomes (10,132 CHD and 4994 stroke outcomes) during a median follow-up of 10.4 years (interquartile range, 7.6-14 years).

MAIN OUTCOME MEASURES: Discrimination of CVD outcomes and reclassification of participants across predicted 10-year risk categories of low (<10\%), intermediate (10\%-<20\%), and high (>=20\%) risk.

RESULTS: The addition of information on various lipid-related markers to total cholesterol, HDL-C, and other conventional risk factors yielded improvement in the model{\textquoteright}s discrimination: C-index change, 0.0006 (95\% CI, 0.0002-0.0009) for the combination of apolipoprotein B and A-I; 0.0016 (95\% CI, 0.0009-0.0023) for lipoprotein(a); and 0.0018 (95\% CI, 0.0010-0.0026) for lipoprotein-associated phospholipase A2 mass. Net reclassification improvements were less than 1\% with the addition of each of these markers to risk scores containing conventional risk factors. We estimated that for 100,000 adults aged 40 years or older, 15,436 would be initially classified at intermediate risk using conventional risk factors alone. Additional testing with a combination of apolipoprotein B and A-I would reclassify 1.1\%; lipoprotein(a), 4.1\%; and lipoprotein-associated phospholipase A2 mass, 2.7\% of people to a 20\% or higher predicted CVD risk category and, therefore, in need of statin treatment under Adult Treatment Panel III guidelines.

CONCLUSION: In a study of individuals without known CVD, the addition of information on the combination of apolipoprotein B and A-I, lipoprotein(a), or lipoprotein-associated phospholipase A2 mass to risk scores containing total cholesterol and HDL-C led to slight improvement in CVD prediction.

}, keywords = {Aged, Biomarkers, Cardiovascular Diseases, Cholesterol, HDL, Cohort Studies, Female, Humans, Lipoproteins, Male, Middle Aged, Risk Assessment}, issn = {1538-3598}, doi = {10.1001/jama.2012.6571}, author = {Di Angelantonio, Emanuele and Gao, Pei and Pennells, Lisa and Kaptoge, Stephen and Caslake, Muriel and Thompson, Alexander and Butterworth, Adam S and Sarwar, Nadeem and Wormser, David and Saleheen, Danish and Ballantyne, Christie M and Psaty, Bruce M and Sundstr{\"o}m, Johan and Ridker, Paul M and Nagel, Dorothea and Gillum, Richard F and Ford, Ian and Ducimetiere, Pierre and Kiechl, Stefan and Koenig, Wolfgang and Dullaart, Robin P F and Assmann, Gerd and D{\textquoteright}Agostino, Ralph B and Dagenais, Gilles R and Cooper, Jackie A and Kromhout, Daan and Onat, Altan and Tipping, Robert W and G{\'o}mez-de-la-C{\'a}mara, Agust{\'\i}n and Rosengren, Annika and Sutherland, Susan E and Gallacher, John and Fowkes, F Gerry R and Casiglia, Edoardo and Hofman, Albert and Salomaa, Veikko and Barrett-Connor, Elizabeth and Clarke, Robert and Brunner, Eric and Jukema, J Wouter and Simons, Leon A and Sandhu, Manjinder and Wareham, Nicholas J and Khaw, Kay-Tee and Kauhanen, Jussi and Salonen, Jukka T and Howard, William J and Nordestgaard, B{\o}rge G and Wood, Angela M and Thompson, Simon G and Boekholdt, S Matthijs and Sattar, Naveed and Packard, Chris and Gudnason, Vilmundur and Danesh, John} }