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Women’s Health Study

Women’s Health Study. The Women’s Health Study (WHS) is an ongoing, randomized, double-blind, placebo-controlled trial of aspirin and vitamin E in >28,000 middle-aged women with no history of CHD.

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Women’s Health Study

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  1. Women’s Health Study • The Women’s Health Study (WHS) is an ongoing, randomized, double-blind, placebo-controlled trial of aspirin and vitamin E in >28,000 middle-aged women with no history of CHD. • This nested case-control study involved Nuclear Magnetic Resonance (NMR) spectroscopy and standard lipid analysis of baseline serum samples from 130 women who experienced CHD events (MI, stroke, CHD death) during three years of follow-up and 130 controls matched for age and smoking status.

  2. Women’s Health Study Hazard ratios for incident CVD events (n=1,015) by quintile Cox regression models were adjusted for age, randomized treatment assignment, smoking status, menopausal status, postmenopausal hormone use, and blood pressure. Likelihood ratio χ 2 statistic evaluates goodness of fit of predictive models. Mora et al. 2007 AHA Scientific Sessions

  3. A prospective comparison of nuclear magnetic resonance lipoprotein profiles in predicting incident diabetes in 26,911 initially healthy women Samia Mora, James Otvos, Aruna Pradhan, Julie E. Buring, Paul M RidkerBrigham and Women’s Hospital, Boston, MA ACC Meeting, April 1 2008

  4. Background: Wilson P and Meigs J, EHJ 2008;10:B11-B15.

  5. Background • LDL cholesterol not a risk factor for type 2 diabetes mellitus (DM2). Whether other measures of LDL (e.g. LDL particle concentration, LDL subclasses, LDL size) are risk factors for DM2 is uncertain. 2. HDL cholesterol and triglycerides are risk factors for DM2. Whether other measures of HDL and VLDL (particle concentration, subclasses, size) are risk factors for DM2 is uncertain.

  6. Objective To compare NMR-measured lipoprotein profiles with chemically-measured standard lipids in predicting clinical diagnosis of DM2

  7. Methods: Study Design • Prospective study of apparently healthy women (Women’s Health Study) • N=26,911 (after excluding baseline DM2, N=762) • Follow-up: 10.9 ± 1.6 y • Main outcome measure: Incident clinical diagnosis of DM2; N=1,156

  8. Methods: Lipids/Lipoprotein Measurements Standard Lipids: Direct measurement of: Total cholesterol LDL cholesterol HDL cholesterol Triglycerides NMR Lipoproteins (LipoScience, Inc.): Particle concentrations LDLNMR, HDLNMR, VLDLNMR and their subclasses Average particle size LDLNMR, HDLNMR, VLDLNMR آپآپهه

  9. Results Baseline Characteristics

  10. LDL Measures *Adjusted for age, smk, ASA/VE assignment, menopause, HRT, BP, BMI

  11. LDL Measures *Adjusted for age, smk, ASA/VE assignment, menopause, HRT, BP, BMI

  12. HDL Measures *Adjusted for age, smk, ASA/VE assignment, menopause, HRT, BP, BMI

  13. HDL Measures *Adjusted for age, smk, ASA/VE assignment, menopause, HRT, BP, BMI

  14. VLDL/Triglyceride Measures *Adjusted for age, smk, ASA/VE assignment, menopause, HRT, BP, BMI

  15. VLDL/Triglyceride Measures *Adjusted for age, smk, ASA/VE assignment, menopause, HRT, BP, BMI

  16. NMR-Measured Particle Size Small Large *Adjusted for age, smk, ASA/VE assignment, menopause, HRT, BP, BMI

  17. Conclusions • The relationships of LDLNMR and HDLNMR subclasses as well as LDLNMR, HDLNMR, and VLDLNMR particle sizes with DM2 remained significant after further adjustment for race, alcohol use, physical activity, family history, HDL cholesterol, triglycerides, hemoglobin A1C, CRP

  18. AACC Position Paper Apolipoprotein B and Cardiovascular Disease Risk: A Position Statement From the AACC Lipoprotein and Vascular Disease Division Working Group on Best Practices • Authors: Contois JH, McConnell JP, Sethi AA, Csako G, Devaraj S, Hoefner DM, and Warnick RG • Objective: Position statement on the role of lipoprotein and cardiovascular disease risk.

  19. Key Points • Patient treated to goal for LDL-C may not have achieved correspondingly low LDL particle concentrations, leaving them with potential residual risk. • LDL-P is consistently more predictive of cardiovascular disease than is LDL-C. • Non-HDL-C, like LDL-C, reflects the cholesterol content of atherogenic particles and not the number of atherogenic particles. Importantly, on treatment non-HDL-C concentrations may not reflect residual risk associated with increased LDL particle number. • Both apolipoprotein B (apo B) and low-density lipoprotein particle (LDL-P) concentration should be recognized and included in guidelines, rather than continuing to focus solely on LDL cholesterol (LDL-C).

  20. Differential Response of Cholesterol and Particle Measures of Atherogenic Lipoproteins to LDL-lowering Therapy: Implications for Clinical Practice Allan D. Sniderman, MD Journal of Clinical Lipidology, Vol 2, No 1, February 2008

  21. Results: LDL-P Journal of Clinical Lipidology, Vol 2, No 1, February 2008

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