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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.

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Authors+Show Affiliations

Ray KK
TIMI Study Group, Cardiovascular Division and the Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA 02115, USA.
Cannon CP
No affiliation info available
Cairns R
No affiliation info available
Morrow DA
No affiliation info available
Ridker PM
No affiliation info available
Braunwald E
No affiliation info available

MeSH

Acute Coronary SyndromeApolipoprotein A-IApolipoproteins BAtorvastatinBiomarkersC-Reactive ProteinCholesterolCholesterol, HDLCoronary DiseaseFemaleHeptanoic AcidsHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMiddle AgedPravastatinPredictive Value of TestsProportional Hazards ModelsPyrrolesRecurrenceRisk AssessmentTime FactorsTreatment Outcome

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 -
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