Moderate tierProspective CohortCitation verified
Discordance of low-density lipoprotein (LDL) cholesterol with alternative LDL-related measures and future coronary events
Samia Mora, Julie E Buring, Paul M Ridker - Circulation, 2014
In healthy women, LDL-C was sometimes discordant with non-HDL-C, apoB, and LDL particle number. When the alternative measures were higher than LDL-C, coronary risk was higher, and vice versa - so risk can be mis-estimated when LDL-C is used alone.
Key findings
- The clinical utility of apoB / LDL particle number appears mainly among people whose values are discordant with LDL-C.
- For women with discordant measures, coronary risk may be underestimated or overestimated when LDL-C alone is used.
Why this evidence tier (Moderate)
- Risk of bias:
- Large, well-conducted prospective cohort with adjudicated events, but observational and single-sex (women only).
- Precision:
- Large sample and long follow-up with 1,070 events give good precision.
- Directness:
- Directly compares the predictive value of LDL-C vs apoB/LDL-P for hard coronary events.
- Consistency:
- Consistent with other discordance analyses.
- Funding / COI:
- See source; Ridker/Mora have disclosed relationships in lipid diagnostics.
Moderate certainty: strong observational evidence that risk tracks particle measures in discordance, limited by observational design and a women-only cohort.
- Population:
- 27,533 healthy women (Women's Health Study); median follow-up 17.2 years; 1,070 incident coronary events.
- Conflicts of interest:
- Not reported on the fetched abstract; authors have disclosed relationships elsewhere in lipid testing.
- Funding:
- Not reported on the fetched abstract.
Limitations
- Observational: residual confounding possible.
- Women-only cohort; generalizability to men not established here.