Non-HDL-C Levels Linked to Risk for Cardiovascular Events

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Levels of non–HDLC among users of statins is linked to the risk for a major cardiovascular event, such as a heart attack or stroke, more strongly than are levels of LDLC and apolipoprotein B. The finding, from a meta-analysis of data from 8 trials comprising a total of 62,154 patients, is published in the March 28 issue of JAMA by S. Matthijs Boekholdt, MD, PhD, from the Academic Medical Center, Amsterdam, the Netherlands.

The meta-analysis looked at individual-patient data from randomized, controlled statin trials published between 1994 and 2008. All study participants had conventional lipids and apolipoprotein levels assessed at baseline and at 1-year follow-up.

Among the 38,153 patients who were randomly assigned to statin therapy, 158 (0.4%) had a fatal myocardial infarction and 1678 (4.4%) had a nonfatal myocardial infarction during follow-up. Death due to other types of coronary artery disease occurred in 615 (1.6%) of the study participants, and fatal or nonfatal stroke occurred in 1029 (2.7%) study participants. In addition, 2806 (7.4%) patients were hospitalized for unstable angina, and 6286 major cardiovascular events (MACE) occurred in 5387 participants, for an event rate of 14.1%. The analysis showed that all the studied lipid and apolipoprotein measures were associated with the risk for MACE and that these associations were statistically significant.

Further analysis showed that the difference between LDL-C and non-HDL-C in predicting the risk for MACE for each 1–standard deviation increase was statistically significant (P = .002). The difference between non-HDL-C and apoB was also statistically significant (P = .02), but the difference between LDL-C and ApoB was not (P = .21).

Given the fact that many other arguments for the clinical applicability of non-HDL-C and LDL-C are identical, non-HDL-C may be a more appropriate target for statin therapy than LDL-C. [Source Medsacpe]


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