Age and Cardiovascular Risk Attributable to Apolipoprotein B, Low‐Density Lipoprotein Cholesterol or Non‐High‐Density Lipoprotein Cholesterol

BACKGROUND: Higher concentrations of the apolipoprotein B (apoB) lipoproteins increase the risk of cardiovascular disease. However, whether the risk associated with apoB lipoproteins varies with age has not been well examined. METHODS AND RESULTS: We determined the associations for total cholesterol, low-density lipoprotein (LDL)-cholesterol (LDL-C), non-high-density lipoprotein-cholesterol (non-HDL-C), apoB, apolipoprotein A-I (apoA-I), and HDL-cholesterol (HDL-C) with myocardial infarction at different ages in 11 760 controls and 8998 myocardial infarction cases of the INTERHEART Study. Logistic regression was used to compute the odds ratio of myocardial infarction for 1 SD change in each lipid marker by decade from <40 to >70 years of age. Except for those >70, plasma levels of total cholesterol, LDL-C, and non-HDL-C and apoB were greater in cases than controls. However, the average levels of these markers decreased significantly as age increased. By contrast, levels of apoA-I and HDL-C were significantly greater in controls than cases but increased significantly as age increased. The cardiovascular risk associated with the atherogenic lipid markers differed at different ages. Most notably, there was a significant decline in the odds ratio for total cholesterol, LDL-C, and non-HDL-C, and apoB with increases in age whereas the odds ratios associated with apoA-I and HDL-C were consistent across the age groups. CONCLUSIONS: These data indicate that the risk of cardiovascular events associated with apoB particles is greater in younger compared to older individuals. This finding is consistent with greater relative benefit from LDL-lowering therapy in younger compared to older individuals and so argues for therapy in younger individuals with elevated lipids.