ApoB and non-HDL cholesterol linked to MI and death risk in statin treated patients: JACC
Denmark: Apolipoprotein B (apoB) and non-HDL cholesterol -- but not LDL cholesterol -- are associated with increased risk of myocardial infarction (MI) and mortality in patients treated with statins, finds a recent study. Also, apoB was found to be more accurate marker of all-cause mortality risk than LDL cholesterol or non-HDL cholesterol, and more accurate marker of MI risk than LDL cholesterol.
The findings of the study are published in the Journal of the American College of Cardiology.
In current guidelines, both American and European, low-density lipoprotein (LDL) cholesterol remains the primary target while apoB) and non–high-density lipoprotein (non-HDL) cholesterol are secondary targets.
"Current guidelines acknowledge the usefulness of both apoB and non–HDL-C in their risk algorithms, and their use as possible targets to indicate efficacy, but they do not yet strongly recommend measurement of apoB for assessment of residual risk," Neil J. Stone and Donald Lloyd-Jones from Northwestern University, Chicago, Illinois, USA, wrote in an accompanying editorial.
Against the above background, Camilla Ditlev Lindhardt Johannesen, Copenhagen University Hospital, Copenhagen, Denmark, and colleagues aimed to determine if elevated apoB and/or non-HDL cholesterol are superior to elevated LDL cholesterol in identifying statin-treated patients at residual risk of all-cause mortality and myocardial infarction.
For the purpose, the researchers included 13,015 statin-treated patients from the Copenhagen General Population Study and followed up for a median of 8 years.
Cox regressions among apoB, non-HDL cholesterol, and LDL cholesterol, respectively, and all-cause mortality or myocardial infarction were examined on continuous scales by restricted cubic splines and by categories of concordant and discordant values defined by medians.
Key findings of the study include:
- High apoB and non-HDL cholesterol were associated with increased risk of all-cause mortality and myocardial infarction, whereas no such associations were found for high LDL cholesterol.
- Compared with concordant values below medians, discordant apoB above the median with LDL cholesterol below yielded hazard ratios of 1.21 for all-cause mortality and 1.49 for myocardial infarction.
- Corresponding values for high non-HDL cholesterol with low LDL cholesterol were 1.18 and 1.78.
- In contrast, discordant high LDL cholesterol with low apoB or non-HDL cholesterol was not associated with increased risk of all-cause mortality or myocardial infarction.
- Discordant high apoB with low non-HDL cholesterol yielded hazard ratios of 1.21 for all-cause mortality and of 0.93 for myocardial infarction.
- Dual discordant apoB and non-HDL cholesterol above the medians with LDL cholesterol below presented hazard ratios of 1.23 for all-cause mortality and 1.82 for myocardial infarction.
"In statin-treated patients, elevated apoB and non-HDL cholesterol, but not LDL cholesterol, are associated with residual risk of all-cause mortality and myocardial infarction," wrote the study authors. "Discordance analysis demonstrates that apoB is a more accurate marker of all-cause mortality risk in statin-treated patients than LDL cholesterol or non-HDL cholesterol, and apoB in addition is a more accurate marker of risk of myocardial infarction than LDL cholesterol."
"In situations where statin use is suboptimal, maximizing statin intensity would appear to be the most important first step in reducing residual risk, and then it may be important to consider how measurement of apoB and non–HDL-C could influence guideline-directed care," wrote Stone and Lloyd-Jones.
Reference:
The study titled, "Apolipoprotein B and Non-HDL Cholesterol Better Reflect Residual Risk Than LDL Cholesterol in Statin-Treated Patients," is published in the Journal of the American College of Cardiology.
DOI: https://www.jacc.org/doi/10.1016/j.jacc.2021.01.027
