Abstract:
BACKGROUND: Dyslipidemia is recognized as a major cause of coronary heart disease
(CHD). Emerged evidence suggests that the combination of triglycerides (TG) and waist
circumference can be used to predict the risk of CHD. However, considering the known
limitations of TG, non-high-density lipoprotein (non-HDL = Total cholesterol - HDL
cholesterol) cholesterol and waist circumference model may be a better predictor of
CHD.
PURPOSE: The Framingham Offspring Study data were used to determine if combined
non-HDL cholesterol and waist circumference is equivalent to or better than TG and
waist circumference (hypertriglyceridemic waist phenotype) in predicting risk of CHD.
METHODS: A total of3,196 individuals from Framingham Offspring Study, aged ~ 40
years old, who fasted overnight for ~ 9 hours, and had no missing information on nonHDL
cholesterol, TG levels, and waist circumference measurements, were included in the
analysis. Receiver Operator Characteristic Curve (ROC) Area Under the Curve (AUC)
was used to compare the predictive ability of non-HDL cholesterol and waist
circumference and TG and waist circumference. Cox proportional-hazards models were
used to examine the association between the joint distributions of non-HDL cholesterol,
waist circumference, and non-fatal CHD; TG, waist circumference, and non-fatal CHD;
and the joint distribution of non-HDL cholesterol and TG by waist circumference strata,
after adjusting for age, gender, smoking, alcohol consumption, diabetes, and hypertension
status.
RESULTS: The ROC AUC associated with non-HDL cholesterol and waist
circumference and TG and waist circumference are 0.6428 (CI: 0.6183, 0.6673) and 0.6299 (CI: 0.6049, 0.6548) respectively. The difference in the ROC AVC is 1.29%. The
p-value testing if the difference in the ROC AVCs between the two models is zero is
0.10. There was a strong positive association between non-HDL cholesterol and the risk
for non-fatal CHD within each TO levels than that for TO levels within each level of nonHDL
cholesterol, especially in individuals with high waist circumference status.
CONCLUSION: The results suggest that the model including non-HDL cholesterol and
waist circumference may be superior at predicting CHD compared to the model including
TO and waist circumference.
