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Concordance between plasma apolipoprotein B levels and cholesterol indices among patients receiving statins and nonstatin treatment: Post-hoc analyses from the U.K. InPractice study.
J Clin Lipidol. 2011 Jul-Aug; 5(4):316-23.JC

Abstract

BACKGROUND

Apolipoprotein B (ApoB) is a superior predictor of low-density-lipoprotein (LDL) particle number and cardiovascular disease (CVD) risk compared with LDL-cholesterol (LDL-C) levels. Current evidence has shown a degree of discordance between LDL-C with ApoB levels among patients not receiving lipid-lowering therapy. The extent of this discordance among patients receiving LDL-lowering therapies however is less clear.

METHODS

We performed a post hoc analysis of the InPractice data looking at the concordance between LDL-C, non-high density lipoprotein-cholesterol (nonHDL-C) and total cholesterol with ApoB values. The study involved 786 high-risk CVD patients from 34 primary care centers initially treated with simvastatin (S) 40 mg at baseline subsequently randomized to adding ezetimibe 10 mg to S 40 mg (E/S40) or changed to atorvastatin (A) 40 mg or to rosuvastatin (R) 5-10 mg for 6 weeks.

RESULTS

At 6 weeks after treatment, the association between LDL-C and ApoB values for the different treatment regimes were similar; Pearson's correlation coefficients between LDL-C and ApoB were 0.84 (E/S40), 0.82 (A), and 0.83 (R). Overall, ApoB appeared to have a slightly greater correlation with nonHDL-C than with LDL-C across all treatment groups, for baseline and posttreatment values. The analysis of quintile frequencies showed a similar pattern; the proportion of patients who had values that fell in the same quintile post treatment for ApoB and LDL-C levels were 52.2% (E/S40), 44.5% (A), and 49.4% (R). Concordance between ApoB and nonHDL-C was 60.6% (E/S40), 62.4% (A), and 61.8% (R). Kappa analysis confirmed fair agreement between LDL-C and ApoB levels for all treatment groups; 0.59 (E/S40), 0.54 (A), and 0.56(R).

CONCLUSION

We showed that the association between ApoB and LDL-C is similar across different lipid-lowering treatment regimes, which suggests that the use of different lipid-lowering agent confers similar ability to predict ApoB levels. When determining CVD risk at an individual patient level, limitation exists when using LDL-C or nonHDL-C per se as risk markers. In the absence of ApoB measurement, we believe that information from both LDL-C and nonHDL-C should be used together to improve the estimation of residual CVD risk among patients who are already receiving lipid lowering therapy.

Authors+Show Affiliations

Department of Diabetes and Endocrinology, Sherwood Forest Hospitals Foundation Trust, Nottinghamshire, UK. iidris@aol.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

21784378

Citation

Idris, Iskandar, et al. "Concordance Between Plasma Apolipoprotein B Levels and Cholesterol Indices Among Patients Receiving Statins and Nonstatin Treatment: Post-hoc Analyses From the U.K. InPractice Study." Journal of Clinical Lipidology, vol. 5, no. 4, 2011, pp. 316-23.
Idris I, Tate H, Ahmad A, et al. Concordance between plasma apolipoprotein B levels and cholesterol indices among patients receiving statins and nonstatin treatment: Post-hoc analyses from the U.K. InPractice study. J Clin Lipidol. 2011;5(4):316-23.
Idris, I., Tate, H., Ahmad, A., & McCormack, T. (2011). Concordance between plasma apolipoprotein B levels and cholesterol indices among patients receiving statins and nonstatin treatment: Post-hoc analyses from the U.K. InPractice study. Journal of Clinical Lipidology, 5(4), 316-23. https://doi.org/10.1016/j.jacl.2011.06.001
Idris I, et al. Concordance Between Plasma Apolipoprotein B Levels and Cholesterol Indices Among Patients Receiving Statins and Nonstatin Treatment: Post-hoc Analyses From the U.K. InPractice Study. J Clin Lipidol. 2011 Jul-Aug;5(4):316-23. PubMed PMID: 21784378.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Concordance between plasma apolipoprotein B levels and cholesterol indices among patients receiving statins and nonstatin treatment: Post-hoc analyses from the U.K. InPractice study. AU - Idris,Iskandar, AU - Tate,Helen, AU - Ahmad,Azhar, AU - McCormack,Terry, Y1 - 2011/06/12/ PY - 2011/03/23/received PY - 2011/05/24/revised PY - 2011/06/01/accepted PY - 2011/7/26/entrez PY - 2011/7/26/pubmed PY - 2011/11/11/medline SP - 316 EP - 23 JF - Journal of clinical lipidology JO - J Clin Lipidol VL - 5 IS - 4 N2 - BACKGROUND: Apolipoprotein B (ApoB) is a superior predictor of low-density-lipoprotein (LDL) particle number and cardiovascular disease (CVD) risk compared with LDL-cholesterol (LDL-C) levels. Current evidence has shown a degree of discordance between LDL-C with ApoB levels among patients not receiving lipid-lowering therapy. The extent of this discordance among patients receiving LDL-lowering therapies however is less clear. METHODS: We performed a post hoc analysis of the InPractice data looking at the concordance between LDL-C, non-high density lipoprotein-cholesterol (nonHDL-C) and total cholesterol with ApoB values. The study involved 786 high-risk CVD patients from 34 primary care centers initially treated with simvastatin (S) 40 mg at baseline subsequently randomized to adding ezetimibe 10 mg to S 40 mg (E/S40) or changed to atorvastatin (A) 40 mg or to rosuvastatin (R) 5-10 mg for 6 weeks. RESULTS: At 6 weeks after treatment, the association between LDL-C and ApoB values for the different treatment regimes were similar; Pearson's correlation coefficients between LDL-C and ApoB were 0.84 (E/S40), 0.82 (A), and 0.83 (R). Overall, ApoB appeared to have a slightly greater correlation with nonHDL-C than with LDL-C across all treatment groups, for baseline and posttreatment values. The analysis of quintile frequencies showed a similar pattern; the proportion of patients who had values that fell in the same quintile post treatment for ApoB and LDL-C levels were 52.2% (E/S40), 44.5% (A), and 49.4% (R). Concordance between ApoB and nonHDL-C was 60.6% (E/S40), 62.4% (A), and 61.8% (R). Kappa analysis confirmed fair agreement between LDL-C and ApoB levels for all treatment groups; 0.59 (E/S40), 0.54 (A), and 0.56(R). CONCLUSION: We showed that the association between ApoB and LDL-C is similar across different lipid-lowering treatment regimes, which suggests that the use of different lipid-lowering agent confers similar ability to predict ApoB levels. When determining CVD risk at an individual patient level, limitation exists when using LDL-C or nonHDL-C per se as risk markers. In the absence of ApoB measurement, we believe that information from both LDL-C and nonHDL-C should be used together to improve the estimation of residual CVD risk among patients who are already receiving lipid lowering therapy. SN - 1933-2874 UR - https://www.unboundmedicine.com/medline/citation/21784378/Concordance_between_plasma_apolipoprotein_B_levels_and_cholesterol_indices_among_patients_receiving_statins_and_nonstatin_treatment:_Post_hoc_analyses_from_the_U_K__InPractice_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1933-2874(11)00608-8 DB - PRIME DP - Unbound Medicine ER -