Jackson Heart Study: Remnant lipoprotein cholesterol predicted MI in black patients

Issue: April 2013

SAN FRANCISCO — Results from the Jackson Heart Study demonstrate that unlike traditional lipid measurements, triglyceride-rich remnant lipoprotein cholesterol was strongly linked with acute MI in black patients. Based on this, researchers said remnant lipoprotein cholesterol prove to be a valuable tool over the traditional lipid panel in assessment of CV risk.

Perspective from Christie M. Ballantyne, MD

“In a cohort of African Americans with no prior cardiovascular disease we’ve seen that remnant lipoprotein cholesterol is strongly associated with incidence of acute myocardial infarction. The strongest association was seen for intermediate density lipoprotein,” Arif Khokhar, BM, BCh, MA, (CANTAB), of the University of Oxford and Northwest London Hospitals, United Kingdom, said during a presentation.

Over 4,000 participants (n=4,722) were included in the prospective, observational Jackson Heart Study of black patients without cardiovascular disease from the Jackson, Mississippi region. Patients were followed for a median 5.7 years. Researchers studied associations between lipoproteins, including triglyceride-rich remnant lipoprotein cholesterol (RLP-C) which was defined as the aggregate of cholesterol from intermediate-density lipoprotein (IDL) and very-low-density lipoprotein-3 (VLDL3), and adjudicated MI. They adjusted for age, sex, BMI, education, alcohol, smoking, blood pressure, lipid-lowering therapy and diabetes.

Seventy-eight MIs occurred among patients (64% women, 53.9±12.8 years). One standard deviation increase in RLP-C predicted a 28% increased risk for MI, according to multivariable analysis (HR=1.28; 95% CI, 1.05-1.55). This was primarily driven by IDL-C, according to Khokhar.

Conversely, the researchers reported that traditional lipid measurements (total cholesterol, LDL-C and non-HDL-C) were not significantly associated with MI. – by Samantha Costa

For more information: Khokhar A. Abstract #919-6. Presented at: American College of Cardiology Scientific Sessions; March 9-11, 2013; San Francisco.

Disclosure: Khokhar reports no relevant financial disclosures.

Perspective

Christie M. Ballantyne, MD

This was a very interesting presentation which points to the fact that we might be able to identify people who have their risk due to specific abnormalities of lipoprotein metabolism. Perhaps they should be tested in trials to see the best way to treat them. It’s something we haven’t done in the past. This type of research is important because it’s probably going to be that not everybody gets the same benefit from therapies. If we understand where their risk is coming from, we might be able to match the therapy to the patient.

Christie M. Ballantyne, MD

Professor of Medicine,

Baylor College of Medicine

Disclosures: Ballantyne reports consulting for Abbott, Adnexus, Amarin, Amylin, AstraZeneca, Bristol-Myers Squibb, Esperion, Genentech, GlaxoSmithKline, Idera Pharma, Kowa, Merck & Co., Novartis, Omthera, Pfizer, Resverlogix, Roche, Sanofi-Synthelabo and Takeda; serving on the speaker's bureau for Abbott, GlaxoSmithKline and Merck & Co.; and receiving research grants from Abbott, Amarin, AstraZeneca, Bristol-Myers Squibb, Genentech, GlaxoSmithKline, Kowa, Merck, Novartis Roche, Sanofi-Synthelabo and Takeda.