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Sex-Related Differences of the Effect of Lipoproteins and Apolipoproteins on 10-Year Cardiovascular Disease Risk; Insights from the ATTICA Study (2002–2012)

1
Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 176 76 Athens, Greece
2
Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia
3
First Cardiology Clinic, School of Medicine, University of Athens, 157 72 Athens, Greece
4
School of Medicine, Sydney, The University of Notre Dame, 128-140 Broadway, Chippendale, NSW 2007, Australia
5
Medical School, Australian National University, Canberra, Canberra, ACT 0200, Australia
*
Author to whom correspondence should be addressed.
Molecules 2020, 25(7), 1506; https://doi.org/10.3390/molecules25071506 (registering DOI)
Received: 22 February 2020 / Revised: 24 March 2020 / Accepted: 24 March 2020 / Published: 26 March 2020
(This article belongs to the Special Issue Lipids in Health and Disease)
The sex-specific effect of lipid-related biomarkers on 10-year first fatal/non fatal cardiovascular disease (CVD) incidence was evaluated. ATTICA study was conducted during 2001–2012. n = 1514 men and n = 1528 women (>18 years) from greater Athens area, Greece were recruited. Follow-up (2011–2012) was achieved in n = 2020 participants. Baseline lipid profile was measured. Overall CVD event was 15.5% (n = 317) (19.7% in men and 11.7% in women, p < 0.001). High density lipoprotein cholesterol (HDL-C) and triglycerides (TAG) were independently associated with CVD in women; per 10 mg/dL HDL-C increase, hazard ratio (HR) = 0.73, 95% confidence interval (95% CI) (0.53, 1.00); and per 10 mg/dL TAG increase, HR = 1.10, 95% CI (1.00, 1.21). Apolipoprotein A1 (ApoA1) (per 10 mg/dL increase, HR = 0.90, 95% CI (0.81, 0.99)) was inversely associated with CVD in women, while a positive association with apolipoprotein B100 (ApoB100) was observed only in men (per 10 mg/dL increase, HR = 1.10, 95% CI (1.00, 1.21)). Non-HDL-C was associated with CVD in the total sample (HR = 1.10, 95% CI (1.00, 1.21)) and in women (HR = 1.10, 95% CI (1.00, 1.21)); a steep increase in HR was observed for values >185 mg/dL in the total sample and in men, while in women, a raise in CVD risk was observed from lower values (>145 mg/dL). As for non-HDL-C/HDL-C and TC/HDL-C ratios, similar trends were observed. Beyond the common cholesterol-adjusted risk scores, reclassifying total CVD risk according to other lipid markers may contribute to early CVD prevention. Biomarkers such as HDL-C, non-HDL-C, and TAG should be more closely monitored in women.
Keywords: heart disease; sex; woman; lipoproteins; apolipoproteins; primary prevention heart disease; sex; woman; lipoproteins; apolipoproteins; primary prevention
MDPI and ACS Style

Kouvari, M.; Panagiotakos, D.B.; Chrysohoou, C.; Georgousopoulou, E.N.; Tousoulis, D.; Pitsavos, C. Sex-Related Differences of the Effect of Lipoproteins and Apolipoproteins on 10-Year Cardiovascular Disease Risk; Insights from the ATTICA Study (2002–2012). Molecules 2020, 25, 1506.

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