Attaining apoB targets may require ‘more aggressive’ treatment goals
MedWire News: Research supports the use of more aggressive lipid-lowering treatment to achieve proposed apolipoprotein (apo)B goals in statin-treated patients with mixed dyslipidemia.
Michel Farnier (Point Médical, Dijon, France) and colleagues showed that, following treatment, the projected low-density lipoprotein (LDL) and non high-density lipoprotein (HDL) cholesterol levels for various levels of apoB were generally less than those supported by current guidelines.
"[Our results] provide a rationale for lowered LDL cholesterol goals that would allow attainment of the corresponding apoB goals," explain the researchers in the Journal of Clinical Lipidology.
They note that current lipid-lowering practice is primarily aimed at lowering LDL cholesterol.
The team combined data from two randomized studies conducted in 1236 mixed dyslipidemic patients (aged 18-79 years), who were receiving treatment with ezetimibe 10 mg, ezetimibe/simvastatin 10/20 mg plus fenofibrate 160 mg, ezetimibe plus fenofibrate 10/160 mg, or ezetimibe/simvastatin plus fenofibrate 10/20/160 mg, or placebo.
Information on serum lipid levels were available for all patients at baseline and after 12 weeks of therapy.
At baseline, the researchers observed relatively strong correlations between LDL or nonHDL cholesterol and apoB. These correlations improved significantly after treatment, and the greatest improvement occurred in groups treated with fenofibrate.
The target levels of LDL and nonHDL cholesterol proposed in the study were 100 mg/dl (2.59 mmol/l) and 130 mg/dl (3.37 mmol/l), respectively.
For treated patients, the LDL and nonHDL cholesterol levels corresponding to an apoB of 90 mg/dl - a level slightly above current American Diabetes Association (ADA) and American College of Cardiology (ACC) Foundation guidelines for very high cardiometabolic risk patients - were lower than these targets, at 90 mg/dl (2.33 mmol/l) and 109 mg/dl (2.82 mmol/l), respectively.
Commenting on their findings, the authors note that levels of triglycerides at baseline could play a role in shifting the observed ratios of LDL cholesterol/apoB. After stratifying treated patients by baseline triglyceride levels (high ≥250 mg/dl [2.83 mmol/l] and low 150-250 mg/dl [1.69-2.83 mmol/l]) they found that the corresponding LDL cholesterol levels for an apoB of 90 mg/dl were generally lower for patients with high triglycerides compared with low triglycerides, at 88 versus 91 mg/dl (2.28 vs 2.36 mmol/l), respectively.
They say: "Our findings clearly indicate that combination therapies that include a statin require lower LDL and nonHDL cholesterol levels than those proposed in current guidelines."
Furthermore, the team says that although there is significant evidence supporting apoB levels as a better treatment endpoint, these results indicate that lowering current LDL cholesterol goals would result in successful attainment of corresponding apoB goals.
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By Nikki Withers