Long-term coronary heart disease risk associated with very-low-density lipoprotein cholesterol in Chinese: the results of a 15-Year Chinese Multi-Provincial Cohort Study (CMCS)

Abstract

Aims: Few studies have examined very-low-density lipoprotein (VLDL) cholesterol as an independent risk factor of coronary heart disease (CHD) or its combined effects with coexisting cardiac risk factors. The current study examined the association between VLDL cholesterol and the risk of future CHD events.

Methods and results: This study reports the association of VLDL cholesterol level and long-term CHD risk, as well as the combined effects of VLDL cholesterol and LDL cholesterol with other cardiovascular disease (CVD) risk factors. The cohort comprises 30,378 participants aged 35-64 years from 11 Chinese provinces. All participants were followed up annually until 2007. We found 20% of the sample population had elevated VLDL cholesterol>or=30 mg/dL. Elevated VLDL cholesterol levels were found to increase CHD risk by 2.19-3.36-fold in people with LDL cholesterol within the normal range and presenting no other major risk factors. This effect was exacerbated in those with elevated LDL cholesterol levels, and further increased CHD risk in those displaying three or more risk factors. The population-attributable risk proportion (PAR%) of CHD associated with VLDL cholesterol was calculated to be 17.3%, higher than that associated with LDL cholesterol alone.

Conclusions: In a large Chinese cohort, elevated VLDL cholesterol was found to be significantly associated with elevated CHD risk, similar to that observed with LDL cholesterol. CHD risk was further amplified when elevated VLDL cholesterol was combined with elevated LDL cholesterol and/or the presence of major CVD risk factors.