On-treatment lipoprotein components and risk of cerebrovascular events in the Treating to New Targets study

Bas van den Bogaard, Bert-Jan H. van den Born, Rana Fayyad, David D. Waters, David A. Demicco, John C. LaRosa, John J. P. Kastelein, Ingar Holme

Research output: Contribution to journalArticleAcademicpeer-review

8 Citations (Scopus)

Abstract

P>Background The Treating to New Targets (TNT) study has recently provided evidence that reduction in LDL-C levels below 2 center dot 6 mmol L-1 lowers the risk of cerebrovascular events by an additional 20% to 25%, thereby confirming the value of statin therapy in preventing transient ischaemic attacks and stroke. Despite the protective effects of statin therapy, the epidemiological association between lipid components and cerebrovascular events is less clear. We therefore assessed the strength of association between in-trial lipoprotein components and cerebrovascular disease in patients receiving intensive lipid-lowering therapy. Methods In 9247 patients (mean age 61 center dot 0 years, 81 center dot 2% males), the association between lipoprotein components and the risk of cerebrovascular events after the first year into the TNT trial was assessed after stratification of lipoprotein components into approximate quartiles. Cox proportional hazards models were used to explore the association between lipoprotein components and time to first cerebrovascular event after adjustment for potential confounding variables. Results All lipoprotein components, except LDL-C, showed a significant gradient for incidence of cerebrovascular events with increasing quartiles of the lipoprotein component. If the lipoprotein components were treated as continuous variables, the adjusted hazard ratios (95% CI) for cerebrovascular events for 1 SD difference in 1-year lipoprotein components were 1 center dot 13 (1 center dot 02-1 center dot 25) for LDL-C, 0 center dot 86 (0 center dot 76-0 center dot 97) for HDL-C, 1 center dot 17 (1 center dot 04-1 center dot 28) for apoB, 0 center dot 83 (0 center dot 74-0 center dot 94) for apoA-1, 1 center dot 22 (1 center dot 10-1 center dot 34) for TC/HDL-C and 1 center dot 24 (1 center dot 12-1 center dot 37) for apoB/apoA-1. Conclusions In coronary heart disease patients receiving intensive lipid-lowering treatment, the on-treatment apoB/apoA-1 ratio provides the strongest association with incidence of cerebrovascular events followed by TC/HDL-C
Original languageEnglish
Pages (from-to)134-142
JournalEuropean journal of clinical investigation
Volume41
Issue number2
DOIs
Publication statusPublished - 2011

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