Received on January 9, 2008
Accepted on May 27, 2008

Lipids, Lipoproteins, and Cardiovascular Risk Factors

Increased Plasma Apolipoprotein C-III Concentration Independently Predicts Cardiovascular Mortality: The Hoorn Study

¹ Metabolic Laboratory, Department of Clinical Chemistry, VU University Medical Center, Amsterdam, and Institute for Cardiovascular Research, VU University Medical Center, Amsterdam
² EMGO Institute, VU University Medical Center, Amsterdam
³ Department of Endocrinology/Diabetes Center, VU University Medical Center, Amsterdam, and Institute for Cardiovascular Research, VU University Medical Center, Amsterdam
⁴ Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam
⁵ Department of Medicine, Division of General Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands

^* To whom correspondence should be addressed. E-mail: p.scheffer{at}vumc.nl.

BACKGROUND: Hypertriglyceridemia is a cardiovascular risk factor. Apolipoprotein C-III (apoC-III) is an important determinant of the catabolic rate of triglyceride-rich lipoproteins. The aim of this study was to investigate the prognostic value of plasma apoC-III concentrations for cardiovascular mortality.

METHODS: We performed this prospective study in 2244 subjects ages 49–77 years who participated in the Hoorn Study. During a mean follow-up of 15 years, 504 individuals died: 231 of cardiovascular disease, 180 of cancer, and 93 of other causes. Cardiovascular disease risk factors and plasma apoC-III concentrations were measured at baseline.

RESULTS: The age- and sex-adjusted plasma apoC-III concentration was prospectively associated with cardiovascular mortality (P < 0.001). After adjustment for traditional risk factors, including fasting triglycerides, the hazard ratio (95% CI) for cardiovascular death between the highest and the lowest quartile of apoC-III was 1.85 (1.02–3.38). High concentrations of apoC-III did not appear to be associated with noncardiovascular mortality.

CONCLUSIONS: In this general population cohort, a high apoC-III concentration in plasma, independently of fasting triglycerides and other traditional risk factors, predicts cardiovascular mortality.