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Meta-analysis of comparison of effectiveness of lowering apolipoprotein B versus low-density lipoprotein cholesterol and nonhigh-density lipoprotein cholesterol for cardiovascular risk reduction in randomized trials.
Am J Cardiol. 2012 Nov 15; 110(10):1468-76.AJ

Abstract

This study evaluated the relation between apolipoprotein B (apoB) decrease and coronary heart disease, stroke, and cardiovascular disease risk. Bayesian random-effects meta-analysis was used to evaluate the association of mean absolute apoB decrease (milligrams per deciliter) with relative risk of coronary heart disease (nonfatal myocardial infarction and coronary heart disease death), stroke (nonfatal stroke and fatal stroke), or cardiovascular disease (coronary heart disease, stroke, and coronary revascularization). Analysis included 25 trials (n = 131,134): 12 on statin, 4 on fibrate, 5 on niacin, 2 on simvastatin-ezetimibe, 1 on ileal bypass surgery, and 1 on aggressive versus standard low-density lipoprotein (LDL) cholesterol and blood pressure targets. Combining the 25 trials, each 10-mg/dl decrease in apoB was associated with a 9% decrease in coronary heart disease, no decrease in stroke, and a 6% decrease in major cardiovascular disease risk. Non-high-density lipoprotein (non-HDL) cholesterol decrease modestly outperformed apoB decrease for prediction of coronary heart disease (Bayes factor [BF] 1.45) and cardiovascular disease (BF 2.07) risk decrease; apoB decrease added to non-HDL cholesterol plus LDL cholesterol decrease slightly improved cardiovascular disease risk prediction (1.13) but did not improve coronary heart disease risk prediction (BF 1.03) and worsened stroke risk prediction (BF 0.83). In the 12 statin trials, apoB and non-HDL cholesterol decreases similarly predicted cardiovascular disease risk; apoB improved coronary heart disease prediction when added to non-HDL cholesterol/LDL cholesterol decrease (BF 3.33) but did not improve stroke risk prediction when added to non-HDL cholesterol/LDL cholesterol decrease (BF 1.06). In conclusion, across all drug classes, apoB decreases did not consistently improve risk prediction over LDL cholesterol and non-HDL cholesterol decreases. For statins, apoB decreases added information to LDL cholesterol and non-HDL cholesterol decreases for predicting coronary heart disease but not stroke or overall cardiovascular disease risk decrease.

Authors+Show Affiliations

University of Iowa, Iowa City, IA, USA. jennifer-g-robinson@uiowa.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

22906895

Citation

Robinson, Jennifer G., et al. "Meta-analysis of Comparison of Effectiveness of Lowering Apolipoprotein B Versus Low-density Lipoprotein Cholesterol and Nonhigh-density Lipoprotein Cholesterol for Cardiovascular Risk Reduction in Randomized Trials." The American Journal of Cardiology, vol. 110, no. 10, 2012, pp. 1468-76.
Robinson JG, Wang S, Jacobson TA. Meta-analysis of comparison of effectiveness of lowering apolipoprotein B versus low-density lipoprotein cholesterol and nonhigh-density lipoprotein cholesterol for cardiovascular risk reduction in randomized trials. Am J Cardiol. 2012;110(10):1468-76.
Robinson, J. G., Wang, S., & Jacobson, T. A. (2012). Meta-analysis of comparison of effectiveness of lowering apolipoprotein B versus low-density lipoprotein cholesterol and nonhigh-density lipoprotein cholesterol for cardiovascular risk reduction in randomized trials. The American Journal of Cardiology, 110(10), 1468-76. https://doi.org/10.1016/j.amjcard.2012.07.007
Robinson JG, Wang S, Jacobson TA. Meta-analysis of Comparison of Effectiveness of Lowering Apolipoprotein B Versus Low-density Lipoprotein Cholesterol and Nonhigh-density Lipoprotein Cholesterol for Cardiovascular Risk Reduction in Randomized Trials. Am J Cardiol. 2012 Nov 15;110(10):1468-76. PubMed PMID: 22906895.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Meta-analysis of comparison of effectiveness of lowering apolipoprotein B versus low-density lipoprotein cholesterol and nonhigh-density lipoprotein cholesterol for cardiovascular risk reduction in randomized trials. AU - Robinson,Jennifer G, AU - Wang,Songfeng, AU - Jacobson,Terry A, Y1 - 2012/08/17/ PY - 2012/05/15/received PY - 2012/07/04/revised PY - 2012/07/04/accepted PY - 2012/8/22/entrez PY - 2012/8/22/pubmed PY - 2013/1/9/medline SP - 1468 EP - 76 JF - The American journal of cardiology JO - Am J Cardiol VL - 110 IS - 10 N2 - This study evaluated the relation between apolipoprotein B (apoB) decrease and coronary heart disease, stroke, and cardiovascular disease risk. Bayesian random-effects meta-analysis was used to evaluate the association of mean absolute apoB decrease (milligrams per deciliter) with relative risk of coronary heart disease (nonfatal myocardial infarction and coronary heart disease death), stroke (nonfatal stroke and fatal stroke), or cardiovascular disease (coronary heart disease, stroke, and coronary revascularization). Analysis included 25 trials (n = 131,134): 12 on statin, 4 on fibrate, 5 on niacin, 2 on simvastatin-ezetimibe, 1 on ileal bypass surgery, and 1 on aggressive versus standard low-density lipoprotein (LDL) cholesterol and blood pressure targets. Combining the 25 trials, each 10-mg/dl decrease in apoB was associated with a 9% decrease in coronary heart disease, no decrease in stroke, and a 6% decrease in major cardiovascular disease risk. Non-high-density lipoprotein (non-HDL) cholesterol decrease modestly outperformed apoB decrease for prediction of coronary heart disease (Bayes factor [BF] 1.45) and cardiovascular disease (BF 2.07) risk decrease; apoB decrease added to non-HDL cholesterol plus LDL cholesterol decrease slightly improved cardiovascular disease risk prediction (1.13) but did not improve coronary heart disease risk prediction (BF 1.03) and worsened stroke risk prediction (BF 0.83). In the 12 statin trials, apoB and non-HDL cholesterol decreases similarly predicted cardiovascular disease risk; apoB improved coronary heart disease prediction when added to non-HDL cholesterol/LDL cholesterol decrease (BF 3.33) but did not improve stroke risk prediction when added to non-HDL cholesterol/LDL cholesterol decrease (BF 1.06). In conclusion, across all drug classes, apoB decreases did not consistently improve risk prediction over LDL cholesterol and non-HDL cholesterol decreases. For statins, apoB decreases added information to LDL cholesterol and non-HDL cholesterol decreases for predicting coronary heart disease but not stroke or overall cardiovascular disease risk decrease. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/22906895/Meta_analysis_of_comparison_of_effectiveness_of_lowering_apolipoprotein_B_versus_low_density_lipoprotein_cholesterol_and_nonhigh_density_lipoprotein_cholesterol_for_cardiovascular_risk_reduction_in_randomized_trials_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(12)01715-8 DB - PRIME DP - Unbound Medicine ER -