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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: results from PROVE IT-TIMI 22.
Arterioscler Thromb Vasc Biol. 2009 Mar; 29(3):424-30.AT

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.

Authors+Show Affiliations

TIMI Study Group, Cardiovascular Division and the Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA 02115, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19122170

Citation

Ray, Kausik K., et al. "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: Results From PROVE IT-TIMI 22." Arteriosclerosis, Thrombosis, and Vascular Biology, vol. 29, no. 3, 2009, pp. 424-30.
Ray KK, Cannon CP, Cairns R, et al. 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: results from PROVE IT-TIMI 22. Arterioscler Thromb Vasc Biol. 2009;29(3):424-30.
Ray, K. K., Cannon, C. P., Cairns, R., Morrow, D. A., Ridker, P. M., & Braunwald, E. (2009). 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: results from PROVE IT-TIMI 22. Arteriosclerosis, Thrombosis, and Vascular Biology, 29(3), 424-30. https://doi.org/10.1161/ATVBAHA.108.181735
Ray KK, et al. 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: Results From PROVE IT-TIMI 22. Arterioscler Thromb Vasc Biol. 2009;29(3):424-30. PubMed PMID: 19122170.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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: results from PROVE IT-TIMI 22. AU - Ray,Kausik K, AU - Cannon,Christopher P, AU - Cairns,Richard, AU - Morrow,David A, AU - Ridker,Paul M, AU - Braunwald,Eugene, Y1 - 2009/01/02/ PY - 2009/1/6/entrez PY - 2009/1/6/pubmed PY - 2009/3/6/medline SP - 424 EP - 30 JF - Arteriosclerosis, thrombosis, and vascular biology JO - Arterioscler Thromb Vasc Biol VL - 29 IS - 3 N2 - 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. SN - 1524-4636 UR - https://www.unboundmedicine.com/medline/citation/19122170/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:_results_from_PROVE_IT_TIMI_22_ L2 - https://www.ahajournals.org/doi/10.1161/ATVBAHA.108.181735?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -