Clinical Investigation
Prevention and Rehabilitation
Race-ethnic differences in the association between lipid profile components and risk of myocardial infarction: The Northern Manhattan Study

https://doi.org/10.1016/j.ahj.2011.01.018Get rights and content

Objective

The aim of this study was to explore race-ethnic differences in the association between plasma lipid components and risk of incident myocardial infarction (MI).

Design/methods

As part of the Northern Manhattan Study, 2,738 community residents without cardiovascular disease were prospectively evaluated. Baseline fasting blood samples were collected, and lipid panel components were analyzed as continuous and categorical variables. Cox proportional hazards models were used to calculate HRs and 95% CIs for incident MI after adjusting for demographic and cardiovascular risk factors.

Results

The mean age was 68.8 ± 10.4 years; 36.7% were men. Of the participants, 19.9% were non-Hispanic white; 24.9%, non-Hispanic black; and 52.8%, Hispanic (>80% from the Caribbean). Hispanics had lower mean high-density lipoprotein cholesterol (HDL-C) and higher triglycerides (TG)/HDL-C. During a mean 8.9 years of follow-up, there were 163 incident MIs. In the whole cohort, all lipid profile components were associated with risk of MI in the expected directions. However, HDL-C (adjusted HR per 10 mg/dL increase 0.93, 95% CI 0.76-1.12) and TG/HDL-C >2 (adjusted HR 0.89, 95% CI 0.51-1.55) were not predictive of MI among Hispanics but were predictive among non-Hispanic blacks and whites. Triglycerides/HDL-C per unit increase was associated with an 8% higher risk of MI among Hispanics (adjusted HR 1.08, 95% CI 1.04-1.12).

Conclusions

In Hispanics, low HDL-C and TG/HDL-C >2 were not associated with MI risk. Our data suggest that a different TG/HDL ratio cutoff may be needed among Hispanics to predict MI risk.

Section snippets

Recruitment of the cohort

The Northern Manhattan Study is a population-based study designed to evaluate the impact of medical, socioeconomic, and other risk factors on the incidence of vascular disease in a stroke-free multiethnic community cohort. Participants were identified by dual-frame random digit dialing in Northern Manhattan as previously described9 and were eligible if they met the following criteria: (1) had never been diagnosed with a stroke; (2) were >39 years old; and (3) resided in Northern Manhattan for

Results

Baseline characteristics for the cohort are outlined in Table I. The mean age of the cohort was 68.8 ± 10.4 years; 36.7% were men. Most of the participants (n = 1,445, 52.8%) were Hispanic, with similar proportions of non-Hispanic blacks and whites making up the rest of the cohort; 45.8% of participants completed high school. There were no significant differences in the proportion of women in each race-ethnicity category. Overall, Hispanics and non-Hispanic blacks had a higher burden of CHD

Discussion

In keeping with prior investigations,7, 17 the mean HDL-C was lower and mean TG was higher in our study among Hispanics compared with non-Hispanic blacks or whites. Non-Hispanic blacks also had a less atherogenic lipid profile than non-Hispanic whites, although we found that the risk of MI was similar for non-Hispanic whites and non-Hispanic blacks except for the models including TG. In our main finding of the TG/HDL-C, non-Hispanic blacks and whites were similar. Compared with results from the

Disclosures

The authors report no conflicts of interest.

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    Funding sources: this project was supported by NINDSR37NS29993. J.Z.W was funded by NINDST32NS07153. C.J.R is supported by a Robert Wood Johnson; Harold Amos Medical Faculty Development Award; and a National Heart, Lung, and Blood Institute's Mentored Patient-Oriented Research Career Development Award (NHLBIK23HL079343-01A2).

    The first author had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All of the authors meet criteria for authorship, including acceptance of responsibility for the scientific content of the article.

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