Association of LDL Cholesterol, Non-HDL Cholesterol, and Apolipoprotein B Levels With Risk of Cardiovascular Events Among Patients Treated With Statins A Meta-analysis

被引：591

作者：

Boekholdt, S. Matthijs ^{[2
]}

Arsenault, Benoit J. ^{[1
]}

Mora, Samia ^{[4
]}

Pedersen, Terje R. ^{[5
,6
]}

LaRosa, John C. ^{[7
]}

Nestel, Paul J. ^{[8
]}

Simes, R. John ^{[9
]}

Durrington, Paul ^{[10
]}

Hitman, Graham A. ^{[11
]}

Welch, K. M. A. ^{[12
]}

DeMicco, David A. ^{[13
]}

Zwinderman, Aeilko H. ^{[3
]}

Clearfield, Michael B. ^{[14
]}

Downs, John R. ^{[15
,16
]}

Tonkin, Andrew M. ^{[18
]}

Colhoun, Helen M. ^{[17
]}

Gotto, Antonio M., Jr. ^{[19
]}

Ridker, Paul M. ^{[4
]}

Kastelein, John J. P. ^{[1
]}

机构：

[1] Univ Amsterdam, Acad Med Ctr, Dept Vasc Med, NL-1105 AZ Amsterdam, Netherlands

[2] Univ Amsterdam, Acad Med Ctr, Dept Cardiol, NL-1105 AZ Amsterdam, Netherlands

[3] Univ Amsterdam, Acad Med Ctr, Dept Clin Epidemiol & Biostat, NL-1105 AZ Amsterdam, Netherlands

[4] Brigham & Womens Hosp, Ctr Cardiovasc Dis Prevent, Boston, MA 02115 USA

[5] Oslo Univ Hosp, Ctr Prevent Med, Ulleval, Norway

[6] Univ Oslo, N-0316 Oslo, Norway

[7] SUNY Hlth Sci Ctr, Brooklyn, NY 11203 USA

[8] Baker Heart & Diabet Res Inst, Melbourne, Vic, Australia

[9] Univ Sydney, NHMRC Clin Trials Ctr, Sydney, NSW 2006, Australia

[10] Univ Manchester, Sch Biomed, Manchester, Lancs, England

[11] Queen Mary Univ London, Barts & London Sch Med & Dent, Ctr Diabet & Metab Med, London, England

[12] Rosalind Franklin Univ Med & Sci, N Chicago, IL USA

[13] Global Pharmaceut Pfizer, New York, NY USA

[14] Touro Univ, Mare Isl, CA USA

[15] Univ Texas Hlth Sci Ctr San Antonio, Dept Med, San Antonio, TX 78229 USA

[16] S Texas Vet Hlth Care Syst, VERDICT, San Antonio, TX USA

[17] Univ Dundee, Med Res Inst, Dundee, Scotland

[18] Monash Univ, Dept Epidemiol & Prevent Med, Melbourne, Vic 3004, Australia

[19] Weill Cornell Med Coll, New York, NY USA

来源：

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2012年 / 307卷 / 12期

关键词：

DENSITY-LIPOPROTEIN CHOLESTEROL; HIGH-DOSE ATORVASTATIN; MYOCARDIAL-INFARCTION; CORONARY EVENTS; PRIMARY PREVENTION; LIPID PARAMETERS; A-I; DISEASE; ATHEROSCLEROSIS; PREDICTION;

D O I：

10.1001/jama.2012.366

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Context The associations of low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and apolipoprotein B (apoB) levels with the risk of cardiovascular events among patients treated with statin therapy have not been reliably documented. Objective To evaluate the relative strength of the associations of LDL-C, non-HDL-C, and apoB with cardiovascular risk among patients treated with statin therapy. Design Meta-analysis of individual patient data from randomized controlled statin trials in which conventional lipids and apolipoproteins were determined in all study participants at baseline and at 1-year follow-up. Data Sources Relevant trials were identified by a literature search updated through December 31, 2011. Investigators were contacted and individual patient data were requested and obtained for 62154 patients enrolled in 8 trials published between 1994 and 2008. Data Extraction Hazard ratios (HRs) and corresponding 95% CIs for risk of major cardiovascular events adjusted for established risk factors by 1-SD increase in LDL-C, non-HDL-C, and apoB. Results Among 38 153 patients allocated to statin therapy, 158 fatal myocardial infarctions, 1678 nonfatal myocardial infarctions, 615 fatal events from other coronary artery disease, 2806 hospitalizations for unstable angina, and 1029 fatal or nonfatal strokes occurred during follow-up. The adjusted HRs for major cardiovascular events per 1-SD increase were 1.13 (95% CI, 1.10-1.17) for LDL-C, 1.16 (95% CI, 1.12-1.19) for non-HDL-C, and 1.14 (95% CI, 1.11-1.18) for apoB. These HRs were significantly higher for non-HDL-C than LDL-C (P=.002) and apoB (P=.02). There was no significant difference between apoB and LDL-C (P=.21). Conclusion Among statin-treated patients, on-treatment levels of LDL-C, non-HDL-C, and apoB were each associated with risk of future major cardiovascular events, but the strength of this association was greater for non-HDL-C than for LDL-C and apoB. JAMA. 2012;307(12):1302-1309 www.jama.com

引用

页码：1302 / 1309

页数：8

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