In:
Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
Abstract:
Background: Lipid management typically focuses on levels of LDL cholesterol (LDL-C) and, to a lesser extent, triglycerides (TG). Basic investigation and genetic studies, however, suggest that the atherogenic particle subpopulations (LDL & VLDL) are similarly important and that the number of particles is more important than their lipid content. Methods: We performed a prospective cohort analysis in two populations: 1) 389,529 primary prevention patients w/o lipid-lowering therapy from UK Biobank, and 2) 45,708 statin-treated patients w/ established atherosclerosis from the FOURIER and IMPROVE-IT trials. Incident MI was assessed over a median follow up of 11.1 yrs in UKBB and 3.6 yrs in the trials. Adjusted HRs were calculated to determine whether lipid content (non-HDL-C & TG) or particle type (using LDL-C concentration as a surrogate for LDL, and TG concentration as a surrogate for TG-rich lipoproteins) offer predictive value beyond atherogenic particle concentration (apoB). Results: In the primary prevention cohort, apoB, non-HDL-C, and TG each individually predicted incident MI. However, when assessed together, only apoB remained a significant predictor (adj HR per 1-SD = 1.28 [95%CI: 1.16,1.42], p 〈 0.0001) ( Fig, A/B ). Similarly, only apoB remained a predictor of MI in the secondary prevention cohort ( Fig, C/D ). Adjusting for apoB, there was no relationship between the ratio of TG to LDL-C (a surrogate for the ratio of TG-rich lipoproteins to LDL) and the risk of MI (p=0.32, Fig, E ), implying that for a given concentration of apoB-containing lipoproteins, the relative proportion of particle subpopulations is not an independent predictor of risk. Conclusion: Risk for MI is best captured by the number of apoB-containing lipoproteins, independent from lipid content (cholesterol or TG) or type of lipoprotein (LDL or TG-rich). Therefore, therapeutic strategies should take into account lowering the overall concentration of all apoB-containing lipoproteins.
Type of Medium:
Online Resource
ISSN:
0009-7322
,
1524-4539
DOI:
10.1161/circ.144.suppl_1.13280
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2021
detail.hit.zdb_id:
1466401-X
