{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:21:15Z","timestamp":1790788875786,"version":"4.1.0"},"reference-count":32,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2020,3,26]],"date-time":"2020-03-26T00:00:00Z","timestamp":1585180800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Molecules"],"abstract":"<jats:p>The sex-specific effect of lipid-related biomarkers on 10-year first fatal\/non fatal cardiovascular disease (CVD) incidence was evaluated. ATTICA study was conducted during 2001\u20132012. n = 1514 men and n = 1528 women (&gt;18 years) from greater Athens area, Greece were recruited. Follow-up (2011\u20132012) was achieved in n = 2020 participants. Baseline lipid profile was measured. Overall CVD event was 15.5% (n = 317) (19.7% in men and 11.7% in women, p &lt; 0.001). High density lipoprotein cholesterol (HDL-C) and triglycerides (TAG) were independently associated with CVD in women; per 10 mg\/dL HDL-C increase, hazard ratio (HR) = 0.73, 95% confidence interval (95% CI) (0.53, 1.00); and per 10 mg\/dL TAG increase, HR = 1.10, 95% CI (1.00, 1.21). Apolipoprotein A1 (ApoA1) (per 10 mg\/dL increase, HR = 0.90, 95% CI (0.81, 0.99)) was inversely associated with CVD in women, while a positive association with apolipoprotein B100 (ApoB100) was observed only in men (per 10 mg\/dL increase, HR = 1.10, 95% CI (1.00, 1.21)). Non-HDL-C was associated with CVD in the total sample (HR = 1.10, 95% CI (1.00, 1.21)) and in women (HR = 1.10, 95% CI (1.00, 1.21)); a steep increase in HR was observed for values &gt;185 mg\/dL in the total sample and in men, while in women, a raise in CVD risk was observed from lower values (&gt;145 mg\/dL). As for non-HDL-C\/HDL-C and TC\/HDL-C ratios, similar trends were observed. Beyond the common cholesterol-adjusted risk scores, reclassifying total CVD risk according to other lipid markers may contribute to early CVD prevention. Biomarkers such as HDL-C, non-HDL-C, and TAG should be more closely monitored in women.<\/jats:p>","DOI":"10.3390\/molecules25071506","type":"journal-article","created":{"date-parts":[[2020,4,3]],"date-time":"2020-04-03T05:55:16Z","timestamp":1585893316000},"page":"1506","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Sex-Related Differences of the Effect of Lipoproteins and Apolipoproteins on 10-Year Cardiovascular Disease Risk; Insights from the ATTICA Study (2002\u20132012)"],"prefix":"10.3390","volume":"25","author":[{"given":"Matina","family":"Kouvari","sequence":"first","affiliation":[{"name":"Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 176 76 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8583-153X","authenticated-orcid":false,"given":"Demosthenes B.","family":"Panagiotakos","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 176 76 Athens, Greece"},{"name":"Faculty of Health, University of Canberra, Bruce ACT 2617, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Chrysohoou","sequence":"additional","affiliation":[{"name":"First Cardiology Clinic, School of Medicine, University of Athens, 157 72 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ekavi N.","family":"Georgousopoulou","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 176 76 Athens, Greece"},{"name":"School of Medicine, Sydney, The University of Notre Dame, 128-140 Broadway, Chippendale NSW 2007, Australia"},{"name":"Medical School, Australian National University, Canberra, Canberra ACT 0200, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Tousoulis","sequence":"additional","affiliation":[{"name":"First Cardiology Clinic, School of Medicine, University of Athens, 157 72 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Pitsavos","sequence":"additional","affiliation":[{"name":"First Cardiology Clinic, School of Medicine, University of Athens, 157 72 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,3,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3232","DOI":"10.1093\/eurheartj\/ehw334","article-title":"Cardiovascular disease in Europe: Epidemiological update 2016","volume":"37","author":"Townsend","year":"2016","journal-title":"Eur. Hear. J."},{"key":"ref_2","first-page":"1243","article-title":"Effectiveness-based guidelines for the prevention of cardiovascular disease in women\u20132011 update: A guideline from the American Heart Association","volume":"123","author":"Mosca","year":"2011","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1177\/0003319718756732","article-title":"Challenges in Sex- and Gender-Centered Prevention and Management of Cardiovascular Disease: Implications of Genetic, Metabolic, and Environmental Paths","volume":"69","author":"Kouvari","year":"2018","journal-title":"Angiology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1093\/eurheartj\/ehz455","article-title":"2019 ESC\/EAS Guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk","volume":"41","author":"Mach","year":"2019","journal-title":"Eur. Hear. J."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Collaborators  CTT, Baigent, C., Blackwell, L., Emberson, J., Holland, E.L., Reith, C., Bhala, N., Peto, R., Barnes, E.H., and Keech, A. (2010). Efficacy and safety of more intensive lowering of LDL cholesterol: A meta-analysis of data from 170 000 participants in 26 randomised trials. Lancet, 376, 1670\u20131681.","DOI":"10.1016\/S0140-6736(10)61350-5"},{"key":"ref_6","unstructured":"Emerging Risk Factors Collaboration, Di Angelantonio, E., Gao, P., Pennells, L., Kaptoge, S., Caslake, M., Thompson, A., Butterworth, A.S., Sarwar, N., and Wormser, D. (2012). Lipid-related markers and cardiovascular disease prediction. JAMA, 307, 2499\u20132506."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2730","DOI":"10.3390\/molecules23112730","article-title":"Current Therapies Focused on High-Density Lipoproteins Associated with Cardiovascular Disease","volume":"23","author":"Vega","year":"2018","journal-title":"Molecules"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.atherosclerosis.2017.04.009","article-title":"Risk of incident myocardial infarction by gender: Interactions with serum lipids, blood pressure and smoking. The Troms\u00f8 Study 1979\u20132012","volume":"261","author":"Albrektsen","year":"2017","journal-title":"Atherosclerosis"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.ahj.2016.09.012","article-title":"Sex differences in lipid profiles and treatment utilization among young adults with acute myocardial infarction: Results from the VIRGO study","volume":"183","author":"Lu","year":"2016","journal-title":"Am. Hear. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1097\/EDE.0b013e31829d2632","article-title":"Risk of Acute Myocardial Infarction","volume":"24","author":"Madssen","year":"2013","journal-title":"Epidemiology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1161\/CIR.0000000000000351","article-title":"Acute Myocardial Infarction in Women: A Scientific Statement from the American Heart Association","volume":"133","author":"Mehta","year":"2016","journal-title":"Circulation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S33","DOI":"10.1016\/j.metabol.2014.10.028","article-title":"Biomarkers of cardiovascular disease risk in women","volume":"64","author":"Manson","year":"2014","journal-title":"Metabolism"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Calling, S., Johansson, S.-E., Wolff, M., Sundquist, J., and Sundquist, K. (2019). The ratio of total cholesterol to high density lipoprotein cholesterol and myocardial infarction in Women\u2019s health in the Lund area (WHILA): A 17-year follow-up cohort study. BMC Cardiovasc. Disord., 19.","DOI":"10.1186\/s12872-019-1228-7"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e005066","DOI":"10.1161\/JAHA.112.005066","article-title":"Sex-Specific Differences in the Predictive Value of Cholesterol Homeostasis Markers and 10-Year Cardiovascular Disease Event Rate in Framingham Offspring Study Participants","volume":"2","author":"Matthan","year":"2013","journal-title":"J. Am. Hear. Assoc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2173","DOI":"10.1016\/S0140-6736(19)32519-X","article-title":"Application of non-HDL cholesterol for population-based cardiovascular risk stratification: Results from the Multinational Cardiovascular Risk Consortium","volume":"394","author":"Brunner","year":"2019","journal-title":"Lancet"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.atherosclerosis.2009.08.026","article-title":"Factors predicting cardiovascular events in statin-treated diabetic and non-diabetic patients with coronary atherosclerosis","volume":"208","author":"Drexel","year":"2010","journal-title":"Atherosclerosis"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1016\/S0140-6736(14)61217-4","article-title":"HDL and cardiovascular disease","volume":"384","author":"Rader","year":"2014","journal-title":"Lancet"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.jacl.2013.08.001","article-title":"High-density lipoproteins: A consensus statement from the National Lipid Association","volume":"7","author":"Toth","year":"2013","journal-title":"J. Clin. Lipidol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.pathol.2018.11.006","article-title":"Non-HDL-cholesterol and apolipoprotein B compared with LDL-cholesterol in atherosclerotic cardiovascular disease risk assessment","volume":"51","author":"Carr","year":"2019","journal-title":"Pathology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"742","DOI":"10.7326\/0003-4819-155-11-201112060-00006","article-title":"Association of High-Density Lipoprotein Cholesterol with Incident Cardiovascular Events in Women, by Low-Density Lipoprotein Cholesterol and Apolipoprotein B100 Levels","volume":"155","author":"Mora","year":"2011","journal-title":"Ann. Intern. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1097\/HJR.0b013e3283213140","article-title":"How much does HDL cholesterol add to risk estimation? A report from the SCORE investigators","volume":"16","author":"Cooney","year":"2009","journal-title":"Eur. J. Cardiovasc. Prev. Rehabilit."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1016\/S0002-9149(03)00319-9","article-title":"Sex and time differences in the associations of non\u2013high-density lipoprotein cholesterol versus other lipid and lipoprotein factors in the prediction of cardiovascular death (The Rancho Bernardo Study)","volume":"91","author":"Langer","year":"2003","journal-title":"Am. J. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1186\/1476-511X-12-159","article-title":"Effects of blood triglycerides on cardiovascular and all-cause mortality: A systematic review and meta-analysis of 61 prospective studies","volume":"12","author":"Liu","year":"2013","journal-title":"Lipids Heal. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1097\/MAJ.0b013e31821da9c0","article-title":"Gender Divergence on the Impact of Multiple Cardiovascular Risk Factors on the Femoral Artery Intima-Media Thickness in Asymptomatic Young Adults: The Bogalusa Heart Study","volume":"343","author":"Paul","year":"2012","journal-title":"Am. J. Med Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s12944-015-0023-4","article-title":"The value of the apoB\/apoA\u0399 ratio and the non-HDL-C\/HDL-C ratio in predicting carotid atherosclerosis among Chinese individuals with metabolic syndrome: A cross-sectional study","volume":"14","author":"Qin","year":"2015","journal-title":"Lipids Heal. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"S4","DOI":"10.1016\/j.jacc.2005.01.072","article-title":"Insights from the NHLBI-Sponsored Women\u2019s Ischemia Syndrome Evaluation (WISE) Study: Part I: Gender differences in traditional and novel risk factors, symptom evaluation, and gender-optimized diagnostic strategies","volume":"47","author":"Shaw","year":"2006","journal-title":"Am. J. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1016\/S0140-6736(04)17018-9","article-title":"Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study","volume":"364","author":"Yusufali","year":"2004","journal-title":"Lancet"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1093\/ije\/26.suppl_1.S118","article-title":"Reproducibility and relative validity of an extensive semi-quantitative food frequency questionnaire using dietary records and biochemical markers among Greek schoolteachers","volume":"26","author":"Katsouyanni","year":"1997","journal-title":"Int. J. Epidemiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.cmpb.2006.05.003","article-title":"MedDietScore: A computer program that evaluates the adherence to the Mediterranean dietary pattern and its relation to cardiovascular disease risk","volume":"83","author":"Panagiotakos","year":"2006","journal-title":"Comput. Methods Programs Biomed."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Pitsavos, C., Panagiotakos, D., Chrysohoou, C., and Stefanadis, C. (2003). Epidemiology of cardiovascular risk factors in Greece: Aims, design and baseline characteristics of the ATTICA study. BMC Public Heal., 3.","DOI":"10.1186\/1471-2458-3-32"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1186\/s12944-015-0101-7","article-title":"Hierarchical modelling of blood lipids\u2019 profile and 10-year (2002-2012) all cause mortality and incidence of cardiovascular disease: The ATTICA study","volume":"14","author":"Nomikos","year":"2015","journal-title":"Lipids Heal. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1177\/0003319719854872","article-title":"Lipoprotein (a) and 10-year Cardiovascular Disease Incidence in Apparently Healthy Individuals: A Sex-based Sensitivity Analysis from ATTICA Cohort Study","volume":"70","author":"Kouvari","year":"2019","journal-title":"Angiology"}],"container-title":["Molecules"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1420-3049\/25\/7\/1506\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:11:59Z","timestamp":1760173919000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1420-3049\/25\/7\/1506"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,26]]},"references-count":32,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2020,4]]}},"alternative-id":["molecules25071506"],"URL":"https:\/\/doi.org\/10.3390\/molecules25071506","relation":{},"ISSN":["1420-3049"],"issn-type":[{"value":"1420-3049","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,26]]}}}