Lipids, lipoproteins and metabolites and risk of incident myocardial infarction and stroke subtypes

Background Blood lipids are established risk factors for myocardial infarction (MI), but uncertainty persists about the relevance of lipids, lipoprotein particles and circulating metabolites for MI and stroke subtypes. Objectives To investigate the associations of plasma metabolic markers with risks of incident MI, ischemic stroke (IS) and intracerebral hemorrhage (ICH). Methods In a nested case-control study (912 MI, 1146 IS, 1138 ICH cases and 1466 common controls) aged 30-79 years in China Kadoorie Biobank, NMR spectroscopy measured 225 metabolic markers in baseline plasma samples. Logistic regression was used to estimate adjusted odds ratios (ORs) for a one standard deviation higher metabolic marker. Results Very-low-, intermediate- and low-density lipoprotein particles were positively associated with MI and IS. HDL particles were inversely associated with MI apart from small HDL. In contrast, no lipoprotein particles associated with ICH. Cholesterol in large HDL was inversely associated with MI and IS (ORs 0.79 and 0.88), whereas cholesterol in small HDL was not (ORs 0.99 and 1.06). Triglycerides within all lipoproteins, including most HDL particles, positively associated with MI, with a similar pattern for IS. Glycoprotein acetyls, ketone bodies, glucose and docosahexaenoic acid associated with all three diseases. The 225 metabolic markers showed concordant associations between MI and IS, but not with ICH. Conclusions Lipoproteins and lipids showed similar associations with MI and IS, but not with ICH. Within HDL particles, cholesterol concentrations were inversely associated, whereas TG concentrations were positively associations with MI. Glycoprotein acetyls and several non-lipid related metabolites associated with all three diseases.