Targeting LDL particle number led to better CV outcomes

WASHINGTON — Managing patients to a target LDL particle number was associated with a reduction in risk for CV events at 3 years compared with managing patients to LDL cholesterol targets, researchers reported at the American College of Cardiology Scientific Sessions.

Terry A. Jacobson, MD, from Emory University, and colleagues hypothesized that the number of LDL particles (LDL-P) would better predict CV outcomes than LDL concentrations (LDL-C), especially in patients with diabetes, metabolic syndrome and hypertriglyceridemia. The hypothesis had not previously been tested in a real-world setting.

The researchers compared risk for CV events at 3 years for high-risk patients achieving an LDL-P target <1,000 nmol/L, as measured by the NMR LipoProfile test (LipoScience Inc.), and high-risk patients achieving an LDL-C target <100 mg/dL.

Using data from the HealthCore Integrated Research Database, Jacobson and colleagues placed patients who achieved the LDL-P target (n=2,094) from January 2006 to September 2012 in one cohort and a propensity-score matched group who had no LDL-P measurements but achieved the LDL-C target (n=2,094) during that time in another cohort.

The primary outcome was a composite of CHD events (defined as MI, unstable angina and revascularization) and stroke at 1, 2 and 3 years.

At 3 years, 14.6% of the LDL-P cohort achieved the primary outcome vs. 19% of the LDL-C cohort (HR=0.75; 95% CI, 0.58-0.97). This was consistent with 1-year results (LDL-P group, 6.26%; LDL-C group, 8.12%; HR=0.76; 95% CI, 0.61-0.96) and 2-year results (LDL-P group, 11%; LDL-C group, 13.9%; HR=0.78; 95% CI, 0.62-0.97).

High-risk patients with known LDL-P were more likely to receive high-potency statins at baseline compared with their counterparts assessed by LDL-C, the researchers reported.

“These new data add to the growing body of evidence suggesting that [nuclear magnetic resonance] measurement of LDL particle number, when used in conjunction with other lipid measurements, is a valuable cardiovascular risk management tool,” Jacobson said in a press release issued by LipoScience. “Due to the wide variance in the cholesterol content of LDL particles among individuals, measurements of LDL cholesterol and LDL particle number frequently disagree, especially in patients with insulin resistance and those treated with lipid-lowering therapies. When a disagreement between LDL-P and LDL-C is present, quantification of LDL particle number is a more clinically reliable measure of LDL and of treatment outcomes than measurement of LDL cholesterol.” – by Erik Swain

For more information:

Jacobson TA. Abstract #1259-150. Presented at: American College of Cardiology Scientific Sessions ; March 29-31, 2014; Washington, D.C.

Disclosure: The study was funded by LipoScience Inc. Jacobson reports consulting for Amgen, AstraZeneca, HealthCore, LipoScience, Merck and Sanofi/Regeneron.