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High LDL particle levels may predict risk for CHD
New research published in Atherosclerosis suggests that elevated LDL particle number may be a better predictor of CHD events than elevated LDL cholesterol.
In the two-part study, researchers assessed measurements of LDL particle number (LDL-P) collected from 15,569 high-risk adults enrolled in the HealthCore Integrated Research Database from Jan. 1, 2006, to Sept. 30, 2012.
“Previous research suggests that LDL particle number may be a better measure of LDL than LDL cholesterol to guide LDL-lowering therapy,” Peter P. Toth, MD, PhD, director of preventive cardiology at CGH Medical Center and clinical professor at University of Illinois School of Medicine, told Cardiology Today. “This large-scale study provides the first real-world evidence supporting the use of LDL particle number as a critical CVD risk management tool, based on the more favorable clinical outcomes we observed in patients achieving target LDL particle number levels, compared to LDL cholesterol targets.”
Peter P. Toth
The first part of the study assessed the incidence of CHD events according to LDL-P thresholds and the second part compared risk for CHD and stroke among patients with an LDL-P <1,000 nmol/L compared with a propensity score-matched cohort of patients with an LDL cholesterol level <100 mg/dL at 12 (n=2,094 matched pairs), 24 (n=1,242) and 36 months (n=705) of follow-up.
About 8.3% of patients in the LDL-P group experienced at least one CHD event. The risk for a CHD event increased significantly along with LDL-P level (HR=1.04; 95% CI, 1.02-1.05 for every 100-nmol/L increase). Significant risk increases were also observed across prespecified LDL-P thresholds of >1,300 nmol/L, >1,600 nmol/L and 2,000 nmol/L.
In the second part of the study, researchers observed that patients who had achieved LDL-P measurements <1,000 nmol/L were at significantly reduced risk for CHD events and stroke, both separately and as a combined endpoint, compared with those who achieved LDL cholesterol measurements <100 mg/dL. The reduction in risk for the combined endpoint was approximately 25% at all three evaluated time points: 12 months: HR=0.76; 95% CI, 0.61-0.96 at 12 months; HR=0.78; 95% CI, 0.62-0.97 at 24 months; and HR=0.75; 95% CI, 0.58-0.97 at 36 months.
The researchers also noted that patients with LDL-P measurements received treatment with intensive lipid-lowering therapies more frequently than those in the LDL cholesterol group.
“These new data add to the growing body of evidence suggesting that nuclear magnetic resonance measurement of LDL particle number is a more clinically reliable measure of LDL for managing CVD,” Toth said. “The results suggest that using LDL cholesterol levels to guide treatment decisions may mask the need to consider changes in lipid-lowering therapy to help patients achieve appropriate reductions in LDL.” – by Adam Taliercio
Disclosure: LipoScience Inc. provided funding for the study. See the full study for a list of the researchers’ relevant financial disclosures.