Prognostic Utility of ApoB/AI, Total Cholesterol/HDL, Non-HDL Cholesterol, or hs-CRP as Predictors of Clinical Risk in Patients Receiving Statin Therapy After Acute Coronary Syndromes
Open Access
- 1 March 2009
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Arteriosclerosis, Thrombosis, and Vascular Biology
- Vol. 29 (3), 424-430
- https://doi.org/10.1161/atvbaha.108.181735
Abstract
Objectives— The purpose of this study was to compare the prognostic utility of apoB/AI, total cholesterol/HDL (TC/HDL) ratio, non-HDL cholesterol (non–HDL-C), or hs-CRP as predictors of clinical risk among patients receiving statin therapy after acute coronary syndromes (ACS). Methods and Results— Patients with ACS were randomized in the PROVE IT–TIMI 22 trial to either pravastatin 40 mg or atorvastatin 80 mg. Cox regression models adjusting for confounders were used to assess the relationship between on-treatment lipids or hs-CRP and risk of death or acute coronary events. At 4 months a 1 SD increment in apoB/AI (HR 1.10, 95% CI 1.01 to 1.20), TC/HDL (HR 1.12, 95% CI 1.01 to 1.24), and non–HDL-C (HR 1.20, 95% CI 1.07 to 1.35) predicted events to a similar extent as LDL-C (HR 1.20, 95% CI 1.07 to 1.35) with neither apoB/AI, TC/HDL, nor non–HDL-C improving risk prediction models which included LDL-C. In contrast, the addition of hs-CRP significantly improved risk prediction models irrespective of the lipid parameters included, with a 29% to 30% increased risk observed per 1 SD increment in log CRP. Conclusion— In the present study of ACS patients receiving statin therapy, on-treatment apoB/AI, TC/HDL, and non–HDL-C offered similar prognostic information to LDL-C. However, the addition of hs-CRP to lipid-based measurements significantly improved risk prediction. On treatment CRP measurement may therefore offer additive prognostic information to lipids in ACS patients.Keywords
This publication has 15 references indexed in Scilit:
- Lipids, Apolipoproteins, and Their Ratios in Relation to Cardiovascular Events With Statin TreatmentCirculation, 2008
- Clinical Utility of Different Lipid Measures for Prediction of Coronary Heart Disease in Men and WomenJAMA, 2007
- Benefits of achieving the NCEP optional LDL-C goal among elderly patients with ACSEuropean Heart Journal, 2006
- Non–High-Density Lipoprotein Cholesterol and Apolipoprotein B in the Prediction of Coronary Heart Disease in MenCirculation, 2005
- Non–HDL Cholesterol, Apolipoproteins A-I and B100, Standard Lipid Measures, Lipid Ratios, and CRP as Risk Factors for Cardiovascular Disease in WomenJAMA, 2005
- C-Reactive Protein Levels and Outcomes after Statin TherapyThe New England Journal of Medicine, 2005
- Prognostic value of apolipoprotein B and A-I in the prediction of myocardial infarction in middle-aged men and women: results from the MONICA/KORA Augsburg cohort studyEuropean Heart Journal, 2004
- Intensive versus Moderate Lipid Lowering with Statins after Acute Coronary SyndromesThe New England Journal of Medicine, 2004
- Rosuvastatin in the Primary Prevention of Cardiovascular Disease Among Patients With Low Levels of Low-Density Lipoprotein Cholesterol and Elevated High-Sensitivity C-Reactive ProteinCirculation, 2003
- Apolipoproteins versus lipids as indices of coronary risk and as targets for statin treatmentThe Lancet, 2003