Association of LDL cholesterol, non-HDL cholesterol, and apolipoprotein B levels with risk of cardiovascular events among patients treated with statins: a meta-analysis
Boekholdt SM, Arsenault BJ, Mora S, Pedersen TR, LaRosa JC, Nestel PJ, Simes RJ, Durrington P, Hitman GA, Welch KM, DeMicco DA, Zwinderman AH, Clearfield MB, Downs JR, Tonkin AM, Colhoun HM, Gotto AM, Ridker PM, Kastelein JJ
JAMA · 568 citas
Etiquetas de revisión
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Cómo se estudió
- Diseño
- Metaanálisis (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación no declarada
Publicación
- Publicado
- 2012-03-27 · JAMA · vol. 307 · número 12 · pág. 1302
- Editorial
- American Medical Association
- Citado
- 797 citas · más que el 100% de estudios similares · 71.3× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 33 trabajos
- Acceso
- De pago
- Áreas de investigación
- Lipoproteins and Cardiovascular Health · Cholesterol and Lipid Metabolism · Cancer, Lipids, and Metabolism
- Palabras clave
- LDL cholesterol, non-HDL cholesterol, apolipoprotein B, statin therapy, cardiovascular risk, major adverse cardiovascular events, lipid-lowering therapy, coronary artery disease, myocardial infarction, stroke, unstable angina, individual patient data meta-analysis, statin trials, residual cardiovascular risk
- MeSH
- humans, cardiovascular diseases, hypercholesterolemia, cholesterol, apolipoproteins b, anticholesteremic agents, hydroxymethylglutaryl-coa reductase inhibitors, risk, cholesterol, ldl, randomized controlled trials as topic, biomarkers
19 autores
- S. Matthijs Boekholdt🇳🇱Amsterdam UMC Location University of Amsterdam
- Benoît J. Arsenault
- Samia Mora
- Terje Rolf Pedersen
- John C. LaRosa
- Paul John Nestel
- Robert John Simes
- Paul N. Durrington
- G. A. Hitman
- Kenneth M. A. Welch
- David A. DeMicco
- Aeilko Having Zwinderman
- Michael B. Clearfield
- John R. Downs
- Andrew Maxwell Tonkin
- Helen Martina Colhoun
- Antonio M. Gotto
- Paul M. Ridker
- John J.P. Kastelein
Resumen
El texto original del estudio, en el idioma en que se publicó.
Context
The associations of low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and apolipoprotein B (apoB) levels with the risk of cardiovascular events among patients treated with statin therapy have not been reliably documented.
Objective
To evaluate the relative strength of the associations of LDL-C, non-HDL-C, and apoB with cardiovascular risk among patients treated with statin therapy.
Design
Meta-analysis of individual patient data from randomized controlled statin trials in which conventional lipids and apolipoproteins were determined in all study participants at baseline and at 1-year follow-up.
Data sources
Relevant trials were identified by a literature search updated through December 31, 2011. Investigators were contacted and individual patient data were requested and obtained for 62,154 patients enrolled in 8 trials published between 1994 and 2008.
Data extraction
Hazard ratios (HRs) and corresponding 95% CIs for risk of major cardiovascular events adjusted for established risk factors by 1-SD increase in LDL-C, non-HDL-C, and apoB.
Results
Among 38,153 patients allocated to statin therapy, 158 fatal myocardial infarctions, 1678 nonfatal myocardial infarctions, 615 fatal events from other coronary artery disease, 2806 hospitalizations for unstable angina, and 1029 fatal or nonfatal strokes occurred during follow-up. The adjusted HRs for major cardiovascular events per 1-SD increase were 1.13 (95% CI, 1.10-1.17) for LDL-C, 1.16 (95% CI, 1.12-1.19) for non-HDL-C, and 1.14 (95% CI, 1.11-1.18) for apoB. These HRs were significantly higher for non-HDL-C than LDL-C (P = .002) and apoB (P = .02). There was no significant difference between apoB and LDL-C (P = .21).
Conclusion
Among statin-treated patients, on-treatment levels of LDL-C, non-HDL-C, and apoB were each associated with risk of future major cardiovascular events, but the strength of this association was greater for non-HDL-C than for LDL-C and apoB.
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