Lipoprotein particles and size, total and high molecular weight adiponectin, and leptin in relation to incident coronary heart disease among severely obese postmenopausal women: The Women's Health Initiative Observational Study

摘要

Background We hypothesized that higher concentrations of {LDL} particles (LDL-P) and leptin, and lower concentrations of {HDL} particles (HDL-P), and total and high molecular weight (HMW) adiponectin, would predict incident coronary heart disease (CHD) among severely obese postmenopausal women. Methods In a case–cohort study nested in the Women's Health Initiative Observational Study, we sampled 677 of the 1852 white or black women with body mass index (BMI) ≥ 40 kg/m2 and no prevalent cardiovascular disease (CVD), including all 124 cases of incident {CHD} over mean 5.0 year follow-up. Biomarkers were assayed on stored blood samples. Results In multivariable-adjusted weighted Cox models, higher baseline levels of total and small LDL-P, and lower levels of total and medium HDL-P, and smaller mean HDL-P size were significantly associated with incident CHD. In contrast, large HDL-P levels were inversely associated with {CHD} only for women without diabetes, and higher total and {HMW} adiponectin levels and lower leptin levels were associated with {CHD} only for women with diabetes. Higher total LDL-P and lower HDL-P were associated with {CHD} risk independently of confounders including {CV} risk factors and other lipoprotein measures, with adjusted {HR} (95% CIs) of 1.55 (1.28, 1.88) and 0.70 (0.57, 0.85), respectively, and similar results for medium HDL-P. Conclusions Higher {CHD} risk among severely obese postmenopausal women is strongly associated with modifiable concentrations of LDL-P and HDL-P, independent of diabetes, smoking, hypertension, physical activity, {BMI} and waist circumference. General significance Severely obese postmenopausal women should be considered high risk candidates for lipid lowering therapy.