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document
VLDL , apolipoproteins B , CIII , and E , and risk of recurrent coronary events in the Cholesterol and Recurrent Events ( CARE ) trial . BACKGROUND Plasma triglyceride concentration has been an inconsistent independent risk factor for coronary heart disease , perhaps because of the metabolic heterogeneity among VLDL particles , the main carriers of triglycerides in plasma . METHODS AND RESULTS We conducted a prospective , nested case-control study in the Cholesterol and Recurrent Events ( CARE ) trial , a randomized placebo-controlled trial of pravastatin in 4159 patients with myocardial infarction and average LDL concentrations at baseline ( 115 to 174 mg/dL , mean 139 mg/dL ) . Baseline concentrations of VLDL-apolipoprotein ( apo ) B ( the VLDL particle concentration ) , VLDL lipids , and apoCIII and apoE in VLDL+LDL and in HDL were compared in patients who had either a myocardial infarction or coronary death ( cases , n=418 ) with those in patients who did not have a cardiovascular event ( control subjects , n=370 ) in 5 years of follow-up . VLDL-cholesterol , VLDL-triglyceride , VLDL-apoB , apoCIII and apoE in VLDL+LDL and apoE in HDL were all interrelated , and each was a univariate predictor of subsequent coronary events . The significant independent predictors were VLDL-apoB ( relative risk [ RR ] 3.2 for highest to lowest quintiles , P : =0.04 ) , apoCIII in VLDL+LDL ( RR 2.3 , P : =0.04 ) , and apoE in HDL ( RR 1.8 , P : =0.02 ) . Plasma triglycerides , a univariate predictor of coronary events ( RR 1.6 , P : =0.03 ) , was not related to coronary events ( RR 1.3 , P : =0.6 ) when apoCIII in VLDL+LDL was included in the model , whereas apoCIII remained significant . Adjustment for LDL- and HDL-cholesterol did not affect these results . CONCLUSIONS The plasma concentrations of VLDL particles and apoCIII in VLDL and LDL are more specific measures of coronary heart disease risk than plasma triglycerides perhaps because their known metabolic properties link them more closely to atherosclerosis .
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Intervention_Control
placebo-controlled
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Intervention_Pharmacological
pravastatin
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Outcome_Physical
VLDL
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Outcome_Physical
apolipoproteins B
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Outcome_Physical
CIII
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Outcome_Physical
E
4722
Outcome_Physical
recurrent coronary events
4723
Outcome_Physical
VLDL-apolipoprotein
4724
Outcome_Physical
B ( the VLDL particle concentration )
4725
Outcome_Physical
VLDL lipids
4726
Outcome_Physical
apoCIII and apoE in VLDL+LDL and in HDL
4727
Outcome_Physical
VLDL-cholesterol , VLDL-triglyceride
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Outcome_Physical
VLDL-apoB
4729
Outcome_Physical
apoCIII and apoE in VLDL+LDL
4730
Outcome_Physical
apoE in HDL
4731
Outcome_Physical
VLDL-apoB
4732
Outcome_Physical
apoCIII in VLDL+LDL
4733
Outcome_Physical
apoE in HDL
4734
Outcome_Physical
Plasma triglycerides
4735
Outcome_Physical
coronary events
4736
Outcome_Physical
coronary events
4737
Outcome_Physical
apoCIII in VLDL+LDL
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Outcome_Physical
apoCIII
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Outcome_Physical
LDL- and HDL-cholesterol
4740
Outcome_Physical
VLDL particles and apoCIII in VLDL and LDL
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Participant_Sample-size
4159
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Participant_Condition
patients with myocardial infarction and average LDL concentrations at baseline ( 115 to 174 mg/dL , mean 139 mg/dL )
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Participant_Condition
patients who had either a myocardial infarction or coronary death
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Participant_Sample-size
n=418
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Participant_Condition
patients who did not have a cardiovascular event
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Participant_Sample-size
n=370