Association of lipid markers with coronary heart disease and stroke mortality: A 15-year follow-up study

Document Type : Original Article

Authors

1 Departments of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Departments of Statistics, Faculty of Mathematical Sciences, Tarbiat Modares University, Tehran, Iran

3 Golestan University of Medical Sciences, Gorgan, Iran

4 Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

5 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

6 Department of Community Medicine, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Objective(s): It has been proposed that lipid markers may predict cardiovascular events; however, their effect may vary depending on the type of cardiovascular disease. The purpose of this study was to investigate the effects of lipid markers on death from coronary heart disease (CHD) and stroke in competing risks setting.
Materials and Methods: Participants included 2502 women and 2020 men, age 40 years or older from Tehran Lipid and Glucose Study. The association between total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), and high-density lipoprotein cholesterol (HDL-C) with hazard and cumulative incidence of CHD and stroke was investigated using cause-specific hazard and sub-distribution hazard models. Statistical analyses were performed using “risk regression” and “cmprsk” package in R 3.3.2.
Results: One standard deviation (SD) increase in TC and LDL-C increased the hazard of CHD death by 1.42 (CI=1.07,1.89) and 1.41 (CI=1.04,1.93), respectively. 1-SD increase in TG increased the cumulative incidence of CHD death increased by 1.94 (CI=1.02,3.75) in women. Other risk factors were not associated with the hazard and cumulative incidence of CHD in women, men and the total sample. In addition, none of lipids had a significant effect on the hazard and cumulative incidence of stroke in men, women and the total sample.
Conclusion: The associations of lipid components on CHD death were modified by gender. TC, LDL-C and TG were independent predictors of CHD mortality in women. Furthermore, death due to stroke changes the association of lipid markers with CHD mortality.

Keywords

Main Subjects

References

1. Organization WH. Cardiovascular disease, On World Heart Day WHO calls for accelerated action to prevent the world’s leading global killer 2018. Available from: http://www.who.int/cardiovascular_diseases/en/.
2. Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart disease and stroke statistics—2018 update: a report from the American Heart Association. Circulation 2018; 137:e67-e492.
3. Organization WH. Noncommunicable Diseases (NCD) Country Profiles, IRAN (ISLAMIC REPUBLIC OF)2018. Available from: http://www.who.int/nmh/countries/irn_en.pdf?ua=1.
4. Global Burden of Disease Study 2015. Global Burden of Disease Study 2015 (GBD 2015) results. Seattle, WA: Institute for Health Metrics and Evaluation (IHME), University of Washington 2016. Available from: http://ghdx.healthdata.org/gbd-results-tool. Accessed May 30, 2017.
5. Canouï-Poitrine F, Luc G, Bard J-M, Ferrieres J, Yarnell J, Arveiler D, et al. Relative contribution of lipids and apolipoproteins to incident coronary heart disease and ischemic stroke: the PRIME Study. Cerebrovascular Diseases 2010; 30:252-259.
6. Iso H, Sato S, Kitamura A, Imano H, Kiyama M, Yamagishi K, et al. Metabolic syndrome and the risk of ischemic heart disease and stroke among Japanese men and women. Stroke 2007; 38:1744-1751.
7. Tohidi M, Mohebi R, Cheraghi L, Hajsheikholeslami F, Aref S, Nouri S, et al. Lipid profile components and incident cerebrovascular events versus coronary heart disease; the result of 9 years follow-up in Tehran Lipid and Glucose Study. Clin Biochem 2013; 46:716-721.
8. Tsukinoki R, Okamura T, Watanabe M, Kokubo Y, Higashiyama A, Nishimura K, et al. Blood pressure, low-density lipoprotein cholesterol, and incidences of coronary artery disease and ischemic stroke in Japanese: the Suita study. Am J Hypertens 2014; 27:1362-1369.
9. Puddu PE, Piras P, Menotti A. Lifetime competing risks between coronary heart disease mortality and other causes of death during 50 years of follow-up. Int J Cardiol 2017; 228:359-363.
10. Liu L, Tang Z, Li X, Luo Y, Guo J, Li H, et al. A novel risk score to the prediction of 10-year risk for coronary artery disease among the elderly in Beijing based on competing risk model. Medicine 2016; 95.
11. Puddu PE, Piras P, Menotti A. Competing risks and lifetime coronary heart disease incidence during 50 years of follow-up. Int J Cardiol 2016; 219:79-83.
12. Prugger C, Wellmann J, Heidrich J, Brand-Herrmann S-M, Keil U. Cardiovascular risk factors and mortality in patients with coronary heart disease. Eur J Epidemiol 2008; 23:731.
13. National Institute of Health DoHaHS. Coronary Heart Disease Risk Factors 2018. Available from: https://www.nhlbi.nih.gov/health-topics/coronary-heart-disease-risk-factors.
14. Amarenco P, Labreuche J, Touboul P-J. High-density lipoprotein-cholesterol and risk of stroke and carotid atherosclerosis: a systematic review. Atherosclerosis 2008; 196:489-496.
15. Overvad TF, Nielsen PB, Larsen TB, Søgaard P. Left atrial size and risk of stroke in patients in sinus rhythm. Thromb Haemost 2016; 116:206-219.
16. Everett BM, Kurth T, Buring JE, Ridker PM. The relative strength of C-reactive protein and lipid levels as determinants of ischemic stroke compared with coronary heart disease in women. J Am Coll Cardiol 2006; 48:2235-2242.
17. Glynn RJ, Rosner B. Comparison of risk factors for the competing risks of coronary heart disease, stroke, and venous thromboembolism. Am J Epidemiol 2005; 162:975-982.
18. Hamer M, Batty GD, Stamatakis E, Kivimaki M. Comparison of risk factors for fatal stroke and ischemic heart disease: A prospective follow up of the health survey for England. Atherosclerosis 2011; 219:807-810.
19. Sadeghpour S, Faghihimani E, Hassanzadeh A, Amini M, Mansourian M. Predictors of all-cause and cardiovascular-specific mortality in type 2 diabetes: A competing risk modeling of an Iranian population. Adv Biomed Res 2016; 5:82.
20. Patterson CC, Blankenberg S, Ben-Shlomo Y, Heslop L, Bayer A, Lowe G, et al. Troponin and BNP are markers for subsequent non-ischaemic congestive heart failure: the Caerphilly Prospective Study (CaPS). Open heart 2018; 5:e000692.
21. Latouche A, Allignol A, Beyersmann J, Labopin M, Fine JP. A competing risks analysis should report results on all cause-specific hazards and cumulative incidence functions. J Clin Epidemiol 2013; 66:648-653.
22. Azizi F, Madjid M, Rahmani M, Emami H, Mirmiran P, Hadjipour R. Tehran Lipid and Glucose Study (TLGS): rationale and design. Iranian journal of endocrinology and metabolism 2000; 2:77-86.
23. Tohidi M, Hatami M, Hadaegh F, Safarkhani M, Harati H, Azizi F. Lipid measures for prediction of incident cardiovascular disease in diabetic and non-diabetic adults: results of the 8.6 years follow-up of a population based cohort study. Lipids Health Dis 2010; 9:6.
24. Azizi F, Ghanbarian A, Momenan AA, Hadaegh F, Mirmiran P, Hedayati M, et al. Prevention of non-communicable disease in a population in nutrition transition: Tehran Lipid and Glucose Study phase II. Trials 2009; 10:5.
25. Azizi F, Rahmani M, Emami H, Mirmiran P, Hajipour R, Madjid M, et al. Cardiovascular risk factors in an Iranian urban population: Tehran lipid and glucose study (phase 1). Soz Praventivmed 2002; 47:408-426.
26. Dianatkhah M, Rahgozar M, Talaei M, Karimloua M, Sadeghi M, Oveisgharan S, et al. Comparison of competing risks models based on cumulative incidence function in analyzing time to cardiovascular diseases. ARYA Atheroscler 2014; 10:6-12.
27. Peters SA, Singhateh Y, Mackay D, Huxley RR, Woodward M. Total cholesterol as a risk factor for coronary heart disease and stroke in women compared with men: A systematic review and meta-analysis. Atherosclerosis 2016; 248:123-131.
Iranian Journal of Basic Medical Sciences
Volume 22, Issue 11
November 2019
Pages 1325-1330

Files

Share

How to cite

Statistics