In Reply: Mr Vos and Dr Rose express concern that our primary end point included revascularization procedures. When these are eliminated from the analysis, among those persons in the top quintile of apolipoprotein B100, the relative risk compared with the lowest quintile is 1.62 (95% confidence [CI], 1.05-2.52); non–HDL cholesterol, 1.91 (95% CI, 1.22-2.99); ratio of total cholesterol to HDL cholesterol, 2.84 (95% CI, 1.76-4.60); and high-sensitivity C-reactive protein, 3.14 (95% CI, 1.80-5.47). Thus, as reported for our primary end point, non–HDL cholesterol and the ratio of total cholesterol to HDL cholesterol were superior to apolipoprotein B100 for the end point of “hard” cardiovascular events, and high-sensitivity C-reactive protein remained the single strongest predictor of risk. The total number of deaths in our study is insufficient to robustly address mortality as a single end point.
Dr Sniderman suggests that apolipoprotein B100 would have been superior to non–HDL cholesterol if we had evaluated only women at higher risk, in particular those with the metabolic syndrome. However, in the subgroup of 3939 women with the metabolic syndrome, the relative risk of 2.1 (95% CI, 1.3-3.3) for future cardiovascular events among those in the top quintile of non–HDL cholesterol compared with the lowest quintile remained identical to that of women in the top quintile of apolipoprotein B100. Furthermore, in our fully adjusted analyses, we found that non–HDL cholesterol significantly added prognostic information to models based on apolipoprotein B100 (χ2 = 7.69; P = .02), yet we found no such additive effect when apolipoprotein B100 was added to models based on non–HDL cholesterol (χ2 = 2.66; P = .24). Thus, in our data, non–HDL cholesterol and apolipoprotein B100 were both correlated and concordant and we found no evidence to suggest either clinical superiority or incremental additive value for apolipoprotein B100 once total cholesterol and HDL cholesterol were known.
Financial Disclosures: Dr Ridker is listed as a coinventor on patents held by the Brigham and Women's Hospital that relate to the use of inflammatory biomarkers in cardiovascular disease. Dr Buring did not report any financial disclosures.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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