J Am Heart Assoc. 2024;13:e031878. DOI: 10.1161/JAHA.123.031878
SUMMARY
This study investigates the impact of discordance between very low-density lipoprotein cholesterol (VLDL-C) and low-density lipoprotein cholesterol (LDL-C) on cardiovascular disease (ASCVD) risk.
AUTHORS
- Kristina E. Seehusen, MPH
- Alan T. Remaley, MD, PhD
- Maureen Sampson, BS
- Jeffrey W. Meeusen, PhD
- Nicholas B. Larson, PhD
- Paul A. Decker, MS
- Jill M. Killian, BS
- Paul Y. Takahashi, MD, MPH
- Véronique L. Roger, MD, MPH
- Sheila M. Manemann, MPH
- Reyna Lam, BS
- Suzette J. Bielinski, PhD
AUTHOR ORGANIZATIONS
- University of Minnesota School of Public Health
- Mayo Clinic, Rochester
- National Institutes of Health (NIH), Bethesda
- Rochester Epidemiology Project
FINDINGS
- VLDL-C is more strongly linked to ASCVD than LDL-C.
- Discordantly high VLDL-C and low LDL-C increase ASCVD risk significantly.
- Lipid discordance suggests possible residual ASCVD risk despite normal LDL-C levels.
STUDY DETAILS
- Large geographically defined cohort of nearly 40,000 individuals.
- 12-year follow-up using clinical lipid panels.
- Use of the Sampson equation to calculate lipid levels.
- Examined ASCVD outcomes like stroke, myocardial infarction, and coronary interventions.
- Concordance and discordance of LDL-C and VLDL-C levels assessed.
STUDY QUALITY
STUDY DESIGN
A large cohort study using clinically derived lipid panel data for longitudinal analysis.
SAMPLE SIZE
Nearly 40,000 participants with a median follow-up of 12 years.
CONFIDENCE INTERVALS
Risk estimates reported with 95% confidence intervals across LDL-C and VLDL-C.
P-VALUE
Results show significant p-values for many associations, particularly VLDL-C and ASCVD risk (p < 0.001).
EFFECT SIZE
VLDL-C had a strong hazard ratio of 1.07 for ASCVD risk per 10 mg/dL increase.
CONSISTENCE OF RESULTS
Consistent results across discordant/concordant lipid pairings and across models.
METHODOLOGY TRANSPARENCY
Methods, such as the use of the Sampson equation, are well documented and replicable.
STUDY REPRODUCIBILITY
The study used established methodologies and publicly accessible data for reproducibility.
DATA ANALYSIS METHOD
Cox proportional hazards regression and generalized additive models used for association analysis.
CONFLICTS OF INTEREST
None detected.
RESEARCHER’S INTERPRETATION
VLDL-C discordance with LDL-C reveals a significant, underrecognized ASCVD risk, requiring enhanced clinical assessments.
PAPER QUALITY
Novelty: 8/10
The focus on VLDL-C discordance offers new insights into residual cardiovascular risk.
Rigor: 9/10
Strong methodology, large sample size, and long-term follow-up provide robust evidence.
Empiricism: 8/10
Empirical evidence was collected over a long period, focusing on clinical outcomes and lipid measurements.
RATING CHART
Known [—–8—-] Novel
Weak [——–9-] Rigorous
Theoretical [—–8—-] Empirical
FINAL SCORE
A
This paper demonstrates novel, rigorous findings, with no conflicts of interest, and provides clear empirical evidence of ASCVD risk associated with VLDL-C.
SUMMARY STATEMENT
VLDL-C discordance increases ASCVD risk, suggesting the need for improved risk assessments in patients with discordant lipid levels, even if LDL-C appears normal.
