Lipids, apolipoproteins, and their ratios in relation to cardiovascular events with statin treatment
Lipids, apolipoproteins, and their ratios in relation to cardiovascular events with statin treatment
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DOI：
10.1161/circulationaha.107.713438
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发表时间：
2008-06-10
期刊：
影响因子：
37.8
通讯作者：
Grundy, Scott M.
中科院分区：
文献类型：
--
作者：
Kastelein, John J. P.;van der Steeg, Wim A.;Grundy, Scott M.
背景-低密度脂蛋白（LDL）胆固醇是降脂治疗的主要靶点，但最近的证据表明更合适的靶点。我们比较了LDL胆固醇、非高密度脂蛋白（HDL）胆固醇和载脂蛋白B的治疗水平，以及总胆固醇/HDL胆固醇、LDL/HDL胆固醇和载脂蛋白B/A-I的比值与接受他汀类药物治疗的患者心血管事件发生率的关系。随机临床试验中，10001例（“治疗新目标”）和8888例（“通过积极降脂治疗逐步降低终点”）确诊冠心病患者被分配接受常规剂量或高剂量他汀类药物治疗。在低密度脂蛋白胆固醇模型中，非高密度脂蛋白胆固醇和载脂蛋白B与心血管结局呈正相关，而与低密度脂蛋白胆固醇的正相关性丢失。在含有非HDL胆固醇和载脂蛋白B的模型中，由于共线性，两者均不显著。总/高密度脂蛋白胆固醇比率和载脂蛋白B/A-I比率，特别是每一个更密切相关的结果比任何个人proatherogenic脂蛋白parameters.Conclusions -在接受他汀类药物治疗的患者中，治疗水平的非高密度脂蛋白胆固醇和载脂蛋白B更密切相关的心血管结局比低密度脂蛋白胆固醇水平。包括抗动脉粥样硬化脂蛋白分数的测量进一步加强了这种关系。这些数据支持使用非HDL胆固醇或载脂蛋白B作为他汀类药物治疗的新治疗靶点。鉴于缺乏已被证明可通过升高血浆HDL胆固醇或载脂蛋白A-I水平持续降低心血管疾病风险的干预措施，认为比值变量具有临床意义似乎为时过早。
Background - Low-density lipoprotein (LDL)cholesterol is the principal target of lipid-lowering therapy, but recent evidence has suggested more appropriate targets. We compared the relationships of on-treatment levels of LDL cholesterol, non-high-density lipoprotein (HDL) cholesterol, and apolipoprotein B, as well as ratios of total/HDL cholesterol, LDL/HDL cholesterol, and apolipoprotein B/A-I, with the occurrence of cardiovascular events in patients receiving statin therapy.Methods and Results - A post hoc analysis was performed that combined data from 2 prospective, randomized clinical trials in which 10 001 ("Treating to New Targets") and 8888 ("Incremental Decrease in End Points through Aggressive Lipid Lowering") patients with established coronary heart disease were assigned to usual-dose or high-dose statin treatment. In models with LDL cholesterol, non-HDL cholesterol and apolipoprotein B were positively associated with cardiovascular outcome, whereas a positive relationship with LDL cholesterol was lost. In a model that contained non-HDL cholesterol and apolipoprotein B, neither was significant owing to collinearity. Total/HDL cholesterol ratio and the apolipoprotein B/A-I ratio in particular were each more closely associated with outcome than any of the individual proatherogenic lipoprotein parameters.Conclusions - In patients receiving statin therapy, on-treatment levels of non-HDL cholesterol and apolipoprotein B were more closely associated with cardiovascular outcome than levels of LDL cholesterol. Inclusion of measurements of the antiatherogenic lipoprotein fraction further strengthened the relationships. These data support the use of non-HDL cholesterol or apolipoprotein B as novel treatment targets for statin therapy. Given the absence of interventions that have been proven to consistently reduce cardiovascular disease risk through raising plasma levels of HDL cholesterol or apolipoprotein A-I, it seems premature to consider the ratio variables as clinically useful.