Relations of change in plasma levels of LDL-C, non-HDL-C and apoB with risk reduction from statin therapy: a meta-analysis of randomized trials.
Level 1 - systematic review of randomized trials
Meta-analysis of randomized controlled trials
PubMed 24732920 · doi:10.1161/JAHA.113.000759
What was done
The authors conducted a random-effects frequentist and Bayesian meta-analysis of 7 placebo-controlled statin trials that measured LDL-C, non-HDL-C, and apoB at baseline and at 1-year follow-up. Summary-level data for changes in each marker were related to relative risk reductions in coronary heart disease (CHD) across the trials.
What was found
Mean CHD risk reduction (95% CI) per standard deviation decrease across the 7 trials was 20.1% (15.6%, 24.3%) for LDL-C, 20.0% (15.2%, 24.7%) for non-HDL-C, and 24.4% (19.2%, 29.2%) for apoB. Within-trial comparisons showed risk reduction per change in apoB averaged 21.6% (95% CI: 12.0%, 31.2%) greater than for LDL-C (P<0.001) and 24.3% (95% CI: 22.4%, 26.2%) greater than for non-HDL-C (P<0.001). Bayesian meta-analyses showed Bayes factors ranging from 484 to 2380 favoring apoB reduction over LDL-C or non-HDL-C.
Why it matters
These findings indicate that apoB reduction relates more closely to clinical cardiovascular risk reduction from statin therapy than changes in LDL-C or non-HDL-C. This provides evidence to support evaluating apoB when monitoring lipid-lowering efficacy.
Limits
The study is restricted to 7 trials with available 1-year apoB data and relies on summary-level rather than individual patient-level data. The abstract does not report the total participant count or specific statin types and doses, and findings from statin trials may not directly extrapolate to non-statin lipid-lowering agents.
Cited by
- supports ApoB or LDL particle number is a superior biomarker to LDL cholesterol, non-HDL cholesterol, triglycerides, and HDL cholesterol for distinguishing cardiovascular disease risk.