Trajectories of Lipids Profile and Incident Cardiovascular Disease Risk: A Longitudinal Cohort Study

Abstract

Background The association between low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides with cardiovascular disease (CVD) has been well studied. No previous studies considered trajectory of these lipids jointly. This study aims to characterize longitudinal trajectories of lipid profile jointly and examine its impact on incident CVD. Methods and Results A total of 9726 participants (6102 men), aged from 20 to 58 years who had lipids repeatedly measured 3 to 9 times, were included in the study. Three distinct trajectories were identified using the multivariate latent class growth mixture model: inverse U-shape (18.72%; n=1821), progressing (66.03%; n=6422), and U-shape (15.25%; n=1483). Compared with the U-shape class, the adjusted hazard ratio and 95% CI were 1.33 (1.05-1.68) and 1.49 (1.14-1.95) for the progressing and inverse U-shape class, respectively. The area under the curve was calculated using the integral of the model parameters. In the adjusted model, total and incremental area under the curve of lipid profile were significantly associated with CVD risk. Furthermore, the model-estimated levels and linear slopes of lipids were calculated at each age point according to the latent class growth mixture model model parameters and their first derivatives, respectively. After adjusting for covariates, standardized odds ratio of slope increases gradually from 1.11 (1.02, 1.21) to 1.21 (1.12, 1.31) at 20 to 40 years and then decreased to 1.02 (0.94, 1.11) until 60 years. Conclusions These results indicate that the lipids profile trajectory has a significant impact on CVD risk. Age between 20 and 42 years is a crucial period for incident CVD, which has implications for early lipids intervention.

Keywords: cardiovascular disease; lipids; longitudinal cohort study; trajectory.

Figure 1

The predicted trajectory of 3 distinct lipid profile for men and women. Solid lines show class‐specific mean predicted levels as a function of age estimated from the best fitting model (3‐class quadratic latent class growth mixture modeling), dashed line indicates estimated 95% CIs. HDL indicates high‐density lipoprotein; LDL, low‐density lipoprotein; TG, triglyceride.

Figure 2

Standardized odds ratio (OR) and 95% CI of model‐estimated levels and linear slopes of lipid profile during the age of 20 to 60 by age for incident CVD, adjusting for sex, smoker, drinker, BMI, diabetes mellitus, SBP, and CVD family history. BMI indicates body mass index; CVD, cardiovascular disease; SBP, systolic blood pressure.