Cardiovascular risk in patients achieving low-density lipoprotein cholesterol and particle targets

Abstract

In this real-world sample of commercially insured patients, higher LDL-P levels were associated with increased CHD risk. Moreover, high-risk patients who achieved LDL-P <1000 nmol/L received more aggressive lipid-lowering therapy than patients achieving LDL-C <100 mg/dL, and these differences in lipids and therapeutic management were associated with a reduction in CHD/stroke events over 12, 24 and 36 months follow-up.

Residual dyslipidemia according to low-density lipoprotein cholesterol, non–high-density lipoprotein cholesterol, and apolipoprotein B among statin-treated US adults: National Health and Nutrition Examination Survey 2009-2010

“…Combinations of multiple classes may be needed against the background of maximally tolerated statin to achieve the goals for atherogenic particle targets (non-HDL-C, LDL-C, ApoB, and LDL-P) particularly in populations with discordantly elevated ApoB-containing lipoproteins (ie, metabolic syndrome, insulin resistance, hypertriglyceridemia, and diabetes). [26][27][28][29][30] Furthermore, newer therapies with a positive risk-benefit profile are warranted that can further close the gap of residual dyslipidemia, especially in higher risk patients where the absolute risk reduction benefit would be most favorable.…”

Effect of PCSK9 Inhibition by Alirocumab on Lipoprotein Particle Concentrations Determined by Nuclear Magnetic Resonance Spectroscopy

“…Because there may be discordance between LDL‐P and LDL‐C levels, some high‐risk patients may achieve currently recommended LDL‐C levels but still remain at risk of cardiovascular events due to elevated LDL‐P levels . In an observational study of high‐risk patients, those who received LDL‐P assessments and achieved LDL‐P concentrations <1000 nmol/L were found to have received higher dose statin therapy and experienced a 22%–25% reduction in cardiovascular event risk over a 3‐year period compared with patients who did not have LDL‐P measurements and achieved an LDL‐C level of <100 mg/dL . Two guidelines committees have incorporated LDL‐P targets as part of their recommendations: The American Association of Clinical Chemistry advocates LDL‐P targets (estimated by apoB measurement) of <1100 nmol/L for high‐risk patients with near‐normal LDL‐C (100 mg/dL), and the American Association of Clinical Endocrinologists recommends goals of <1000 nmol/L for LDL‐P and <70 mg/dL for LDL‐C among diabetic patients at high risk of cardiovascular disease .…”

Discordance of Low-Density Lipoprotein and High-Density Lipoprotein Cholesterol Particle Versus Cholesterol Concentration for the Prediction of Cardiovascular Disease in Patients With Metabolic Syndrome and Diabetes Mellitus (from the Multi-Ethnic Study of Atherosclerosis [MESA])

“…The American Association of Clinical Endocrinologists recently specified an LDL-P target of <1,200 nmol/L for moderate CVD risk and LDL-P target of <1,000 nmol/L for high CVD risk, 27 supported by evidence that high-risk patients who achieve LDL-P <1,000 nmol/L compared with an LDL-C <100 mg/dl had a greater reduction in CVD events. 28 Our study shows that in subjects with MetS greater LDL discordance is associated with future CVD events. We show that HDL-P, not HDL-C, is inversely related to CVD events.…”