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Relations of change in plasma levels of LDL-C, non-HDL-C and apoB with risk reduction from statin therapy: a meta-analysis of randomized trials.
J Am Heart Assoc. 2014 Apr 14; 3(2):e000759.JA

Abstract

BACKGROUND

Identifying the best markers to judge the adequacy of lipid-lowering treatment is increasingly important for coronary heart disease (CHD) prevention given that several novel, potent lipid-lowering therapies are in development. Reductions in LDL-C, non-HDL-C, or apoB can all be used but which most closely relates to benefit, as defined by the reduction in events on statin treatment, is not established.

METHODS AND RESULTS

We performed a random-effects frequentist and Bayesian meta-analysis of 7 placebo-controlled statin trials in which LDL-C, non-HDL-C, and apoB values were available at baseline and at 1-year follow-up. Summary level data for change in LDL-C, non-HDL-C, and apoB were related to the relative risk reduction from statin therapy in each trial. In frequentist meta-analyses, the mean CHD risk reduction (95% CI) per standard deviation decrease in each marker across these 7 trials were 20.1% (15.6%, 24.3%) for LDL-C; 20.0% (15.2%, 24.7%) for non-HDL-C; and 24.4% (19.2%, 29.2%) for apoB. Compared within each trial, risk reduction per change in apoB averaged 21.6% (12.0%, 31.2%) greater than changes in LDL-C (P<0.001) and 24.3% (22.4%, 26.2%) greater than changes in non-HDL-C (P<0.001). Similarly, in Bayesian meta-analyses using various prior distributions, Bayes factors (BFs) favored reduction in apoB as more closely related to risk reduction from statins compared with LDL-C or non-HDL-C (BFs ranging from 484 to 2380).

CONCLUSIONS

Using both a frequentist and Bayesian approach, relative risk reduction across 7 major placebo-controlled statin trials was more closely related to reductions in apoB than to reductions in either non-HDL-C or LDL-C.

Authors+Show Affiliations

Preventive and Genomic Cardiology, McGill University Health Centre, Department of Medicine, Montreal, Quebec, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24732920

Citation

Thanassoulis, George, et al. "Relations of Change in Plasma Levels of LDL-C, non-HDL-C and apoB With Risk Reduction From Statin Therapy: a Meta-analysis of Randomized Trials." Journal of the American Heart Association, vol. 3, no. 2, 2014, pp. e000759.
Thanassoulis G, Williams K, Ye K, et al. Relations of change in plasma levels of LDL-C, non-HDL-C and apoB with risk reduction from statin therapy: a meta-analysis of randomized trials. J Am Heart Assoc. 2014;3(2):e000759.
Thanassoulis, G., Williams, K., Ye, K., Brook, R., Couture, P., Lawler, P. R., de Graaf, J., Furberg, C. D., & Sniderman, A. (2014). Relations of change in plasma levels of LDL-C, non-HDL-C and apoB with risk reduction from statin therapy: a meta-analysis of randomized trials. Journal of the American Heart Association, 3(2), e000759. https://doi.org/10.1161/JAHA.113.000759
Thanassoulis G, et al. Relations of Change in Plasma Levels of LDL-C, non-HDL-C and apoB With Risk Reduction From Statin Therapy: a Meta-analysis of Randomized Trials. J Am Heart Assoc. 2014 Apr 14;3(2):e000759. PubMed PMID: 24732920.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relations of change in plasma levels of LDL-C, non-HDL-C and apoB with risk reduction from statin therapy: a meta-analysis of randomized trials. AU - Thanassoulis,George, AU - Williams,Ken, AU - Ye,Keying, AU - Brook,Robert, AU - Couture,Patrick, AU - Lawler,Patrick R, AU - de Graaf,Jacqueline, AU - Furberg,Curt D, AU - Sniderman,Allan, Y1 - 2014/04/14/ PY - 2014/4/16/entrez PY - 2014/4/16/pubmed PY - 2014/11/19/medline KW - LDL‐C KW - apoB KW - meta‐analysis KW - non‐HDL‐C KW - statins SP - e000759 EP - e000759 JF - Journal of the American Heart Association JO - J Am Heart Assoc VL - 3 IS - 2 N2 - BACKGROUND: Identifying the best markers to judge the adequacy of lipid-lowering treatment is increasingly important for coronary heart disease (CHD) prevention given that several novel, potent lipid-lowering therapies are in development. Reductions in LDL-C, non-HDL-C, or apoB can all be used but which most closely relates to benefit, as defined by the reduction in events on statin treatment, is not established. METHODS AND RESULTS: We performed a random-effects frequentist and Bayesian meta-analysis of 7 placebo-controlled statin trials in which LDL-C, non-HDL-C, and apoB values were available at baseline and at 1-year follow-up. Summary level data for change in LDL-C, non-HDL-C, and apoB were related to the relative risk reduction from statin therapy in each trial. In frequentist meta-analyses, the mean CHD risk reduction (95% CI) per standard deviation decrease in each marker across these 7 trials were 20.1% (15.6%, 24.3%) for LDL-C; 20.0% (15.2%, 24.7%) for non-HDL-C; and 24.4% (19.2%, 29.2%) for apoB. Compared within each trial, risk reduction per change in apoB averaged 21.6% (12.0%, 31.2%) greater than changes in LDL-C (P<0.001) and 24.3% (22.4%, 26.2%) greater than changes in non-HDL-C (P<0.001). Similarly, in Bayesian meta-analyses using various prior distributions, Bayes factors (BFs) favored reduction in apoB as more closely related to risk reduction from statins compared with LDL-C or non-HDL-C (BFs ranging from 484 to 2380). CONCLUSIONS: Using both a frequentist and Bayesian approach, relative risk reduction across 7 major placebo-controlled statin trials was more closely related to reductions in apoB than to reductions in either non-HDL-C or LDL-C. SN - 2047-9980 UR - https://www.unboundmedicine.com/medline/citation/24732920/Relations_of_change_in_plasma_levels_of_LDL_C_non_HDL_C_and_apoB_with_risk_reduction_from_statin_therapy:_a_meta_analysis_of_randomized_trials_ L2 - https://www.ahajournals.org/doi/10.1161/JAHA.113.000759?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -