Multiple lipid scoring system for prediction of coronary heart disease risk: application to African Americans.

BACKGROUND

Clinicians often obtain a panel of lipids but then only use low-density-lipoprotein (LDL) cholesterol to make clinical decisions. We previously described the multiple lipid measure, a strategy that integrates information about seven lipid measures. Our current inquiry uses the multiple lipid measure to create a scoring system and validates that system in a second cohort.

METHODS AND RESULTS

A scoring system that uses total cholesterol, high-density lipoprotein (HDL) cholesterol, LDL cholesterol and triglycerides was developed and tested. African-American participants of the Atherosclerosis Risk in Communities (ARIC) Study were used to validate the multiple lipid measure score. For nonsmokers, scores > or = 2 had a hazard ratio of 4.25 (95% CI 1.92-9.40) compared to reference scores of < or = -3 in adjusted survival analysis predicting incident coronary heart disease risk in the ARIC. The best conventional single lipid measure for nonsmokers was LDL cholesterol. Compared to LDL cholesterol <100 mg/dl, those with LDL cholesterol > or = 160 mg/dl had a hazard ratio of 2.31 (95% CI 1.13-4.75). For current smokers, the best conventional lipid measure was the total cholesterol/HDL cholesterol ratio, which was similar in predictive ability to the multiple lipid measure score. However, the multiple lipid measure score predicted an additional 10% of the cohort at risk compared to the total cholesterol/HDL cholesterol ratio.

CONCLUSIONS

The use of the multiple lipid scoring system improves the assessment of incident coronary heart disease risk and may have utility for clinicians in integrating lipid values.