Discordance Between Very Low-Density Lipoprotein Cholesterol and Low-Density Lipoprotein Cholesterol Increases...

Area of Science:

• Cardiology
• Lipidology
• Preventive Medicine

Background:

• Clinical risk scores are essential for identifying individuals at high risk of atherosclerotic cardiovascular disease (ASCVD).
• Despite preventive strategies, a significant residual risk of ASCVD persists in many populations.
• Very low-density lipoprotein cholesterol (VLDL-C) and lipid discordance are potential contributors to this residual ASCVD risk.

Purpose of the Study:

• To investigate the association between VLDL-C, lipid discordance, and incident ASCVD.
• To determine if VLDL-C, estimated from standard lipid panels, can improve ASCVD risk assessment.

Main Methods:

• A cohort of 39,098 cardiovascular disease-free residents aged ≥40 years in Olmsted County, Minnesota, was analyzed.
• Low-density lipoprotein cholesterol (LDL-C) and VLDL-C were calculated using the Sampson equation from clinical lipid panels.
• Participants were classified into concordant or discordant lipid groups; incident ASCVD events were tracked and analyzed using Cox regression.

Main Results:

• An increase in VLDL-C (per 10 mg/dL) was significantly associated with higher ASCVD risk (HR, 1.07; P<0.001), independent of traditional risk factors.
• No statistically significant interaction was found between LDL-C and VLDL-C (P=0.11).
• Individuals with high VLDL-C and low LDL-C (discordant group) exhibited the highest incidence rate of ASCVD events (16.9 per 1000 person-years).

Conclusions:

• VLDL-C and lipid discordance are significantly associated with an increased risk of ASCVD.
• VLDL-C can be readily estimated from routine lipid panels.
• Incorporating VLDL-C and assessing lipid discordance may enhance the accuracy of ASCVD risk prediction.