Association of Blood Lipid Markers and 20-year Cardiovascular Disease Incidence: The ATTICA Epidemiological Cohort Study (2002–2022)

Background: The association of blood lipids and apolipoproteins with cardiovascular disease (CVD) is well established. However, there are ongoing discussions on which lipid biomarker could better predict CVD risk in the long term. Aim: To investigate the association of blood lipid profile biomarkers with 20-year incidence of CVD. Materials and Methods: The ATTICA study is a population-based cohort study investigating CVD incidence and relevant risk factors, including lipids, in 3042 primary prevention population of the metropolitan region of Athens. In 2022, the 20-year follow-up was performed in 2169 individuals who agreed to participate. Analyses were adjusted for gender, age, body mass index, smoking, physical activity, adherence to Mediterranean diet, family CVD history, hypertension, diabetes, and lipid-lowering medication at baseline. Results: In total, information from 1988 individuals was analyzed in 20-year follow-up (50% men, 37% family CVD history, 31% hypertension, 7% diabetes, 55% current/past smoking, 18% obesity, 43% hypercholesterolemia, and 12% on lipid-lowering drugs at baseline). During the follow-up, 718 (36.1%) individuals experienced a first CVD event. Total cholesterol, low-density lipoprotein cholesterol (LDL-C), non-high-density-lipoprotein cholesterol (non-HDL-C), and apolipoprotein B were independent predictors of CVD. Among lipid indices, non-HDL-C and LDL-C demonstrated the best correct reclassification ability (continuous Net Reclassification Improvement = 38.4% and 38.0%, respectively). Conclusions: Non-HDL-C has a similar ability with LDL-C to predict and reclassify 20-year CVD incidence in a middle-aged, apparently healthy population.