On-treatment levels of non-high-density lipoprotein cholesterol (non-HDL-C) and, to a lesser extent, low-density lipoprotein cholesterol (LDL-C) and apolipoprotein B (apoB) are each associated with risk of future major cardiovascular events for patients on statin therapy, according to a study published in the March 28 issue of the Journal of the American Medical Association.
S. Matthijs Boekholdt, MD, PhD, of the Academic Medical Center in Amsterdam, and colleagues conducted a meta-analysis of individual patient data from randomized controlled statin trials in which conventional lipids and apolipoproteins were determined in all participants at baseline and at one year. Individual patient data were obtained for 62,154 patients enrolled in eight trials published between 1994 and 2008.
The researchers found that, during follow-up of 38,153 patients allocated to statin therapy, 158 fatal myocardial infarctions, 1,678 nonfatal myocardial infarctions, 615 fatal events from other coronary artery disease, 2,806 hospitalizations for unstable angina, and 1,029 fatal or nonfatal strokes occurred. The adjusted hazard ratios (HRs) for major cardiovascular events per 1 standard deviation increase were 1.13 for LDL-C, 1.16 for non-HDL-C, and 1.14 for apoB. These HRs were significantly higher for non-HDL-C than LDL-C (P = 0.002) and apoB (P = 0.02), but not significantly different between apoB and LDL-C (P = 0.21).
"Among statin-treated patients, on-treatment levels of LDL-C, non-HDL-C, and apoB were each associated with risk of future major cardiovascular events, but the strength of this association was greater for non-HDL-C than for LDL-C and apoB," the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.
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