Clinical Benefit of Lowering LDL-C May Depend on How It Is Lowered

Change in apoB levels may be better predictor of clinical response than LDL-C, HDL-C levels
Change in apoB levels may be better predictor of clinical response than LDL-C, HDL-C levels

(HealthDay News) — Clinical benefit of reduced low-density lipoprotein cholesterol (LDL-C) levels may depend on the corresponding reduction in apolipoprotein B (apoB)-containing lipoprotein particles, according to a study published online Aug. 28 in the Journal of the American Medical Association. The research was published to coincide with the European Society of Cardiology Congress 2017, held from Aug. 26 to 30 in Barcelona, Spain.

Brian A. Ference, M.D., M.Phil., from the Wayne State University School of Medicine in Detroit, and colleagues conducted a primary analysis, including 102,837 participants with 13,821 major cardiovascular events, and validation analyses, including 189,539 participants with 62,240 cases of coronary heart disease, to estimate the correlation between changes in lipoprotein level and cardiovascular event risk.

The researchers found that the CETP score correlated with higher levels of high-density lipoprotein cholesterol, lower LDL-C, and lower apoB, resulting in lower risk of major vascular events (odds ratio, 0.946; 95 percent confidence interval, 0.921 to 0.972), when considered alone; this was similar in magnitude to the changes seen for the HMGCR score. The CETP score combined with the HMGCR score correlated with the same reduction in LDL-C levels, but a smaller decrease in apoB levels, and a nonsignificant reduction in the risk of major cardiovascular events (odds ratio, 0.985; 95 percent confidence interval, 0.955 to 1.15).

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"From the standpoint of the clinician, these data provide additional support to an already large body of evidence indicating that apoB is a superior marker of cardiovascular disease risk than LDL-C," writes the author of an accompanying editorial. "Given the need to further improve prevention of cardiovascular disease, these data suggest that it may well be time to introduce measuring and monitoring apoB levels into routine clinical care."

Several authors disclosed financial ties to the pharmaceutical industry.

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