Lipoprotein subclass abnormalities and incident hypertension in initially healthy women.

BACKGROUND Abnormalities in traditional lipids, particularly decreased HDL cholesterol and increased triglycerides, can precede the onset of hypertension. Whether lipoprotein particle size or subclass concentrations play a role in the development of hypertension is unknown. METHODS We followed 17 527 initially healthy women without baseline hypertension prospectively for 8 years. At baseline, information regarding traditional lipids and hypertension risk factors was obtained, and lipoprotein size and subclass concentrations were measured by nuclear magnetic resonance spectroscopy. RESULTS Baseline lipoprotein size and subclass concentrations were significantly associated with incident hypertension. Although LDL cholesterol was not associated with hypertension [odds ratio (OR) for quintile 5 vs 1: 1.08 (95% CI 0.96-1.20)], increased concentrations of LDL particles were associated with greater risk [OR 1.73 (1.54-1.95)], especially small LDL particles [OR 1.62 (1.45-1.83)]. Increased HDL cholesterol was associated with lower risk of hypertension [OR for quintile 5 vs 1: 0.79 (0.70-0.89)]. By contrast, increased concentrations of HDL particles had greater risk [OR 1.48 (1.32-1.67)], especially small HDL particles [OR 1.36 (1.22-1.53)], whereas large HDL particles had lower risk [OR 0.80 (0.71-0.90)]. Triglycerides and triglyceride-rich VLDL particles were positively associated with hypertension, with large VLDL particles associated with greater risk [OR 1.68 (1.50-1.89)]. Adding particle subclasses improved discrimination over a model with traditional lipids and risk factors (c-statistic 0.671 compared to 0.676; P < 0.001). CONCLUSIONS In this study of initially healthy women, lipoprotein particle size and subclass concentrations were associated with incident hypertension and provided additive information to traditional lipids and risk factors.