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Predictive value of remnant lipoprotein for cardiovascular events in patients with coronary artery disease after achievement of LDL-cholesterol goals
Atherosclerosis, 09/06/2011
Nakamura T et al. – Remnant–like lipoprotein particles cholesterol (RLP–C) was superior to non–HDL–C for predicting cardiovascular events in CAD patients with low–density lipoprotein cholesterol (LDL–C) levels <100mg/dL on lipid–lowering treatment. Remnant lipoprotein may therefore be an important target for residual risk reduction after LDL–C goals on lipid lowering therapy.
Methods- Serum levels of remnant lipoproteins (remnant–like lipoprotein particles cholesterol; RLP–C) were measured by an immunoseparation method in 560 patients with CAD who had LDL–C levels <100mg/dL on lipid–lowering therapy, including statin (58%), fibrate (13%) or diet only (29%).
- All the patients were followed prospectively for a period of ≤36 months or until occurrence of one of the following events: cardiac death, non fatal myocardial infarction, unstable angina requiring coronary revascularization, or ischemic stroke.
- During a mean follow–up period of 33 months, 40 events occurred.
- Stepwise multivariate Cox proportional hazard analysis showed that RLP–C was a significant predictor of cardiovascular events after adjustment for known risk factors and lipid variables including triglycerides, non–high–density lipoprotein (HDL)–C, and total apolipoprotein B (HR 1.53, 95% CI 1.35–1.97, p<0.01).
- The c–statistics showed that addition of RLP–C had a greater incremental effect on the predictive value of conventional risk factors than addition of non–HDL–C or total apolipoprotein B.