The report from The Emerging Risk Factors Collaboration1 in this issue of JAMA was designed to determine whether adding apolipoproteins and lipoproteins to routine measurements of total cholesterol and HDL cholesterol (HDL-C) is associated with improved risk prediction for cardiovascular disease (CVD). The additional measurements included apolipoprotein B and A-I, lipoprotein(a), and lipoprotein-associated phospholipase A2. In this large, multicenter study that included 165 544 patients without baseline CVD from 37 prospective cohorts, there were 15 126 new fatal or nonfatal CVD outcomes over a median follow-up of 10.4 years. Overall, replacement of total cholesterol and HDL-C with apolipoproteins or their ratios was not associated with improved CVD risk prediction, whereas adding lipoprotein factors to total cholesterol and HDL-C was associated with slight improvement in CVD risk prediction.
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