AIMS/HYPOTHESIS: Controversy surrounds whether the ratio of apolipoprotein B (ApoB) to apolipoprotein A-I (ApoA-I) is the best lipoprotein discriminator of CHD risk in non-diabetic populations, but the issue has never been investigated in type 2 diabetes. METHODS: In 2,627 participants without known vascular disease in the Collaborative Atorvastatin Diabetes Study, ApoB, ApoA-I, LDL-cholesterol (LDLC) and HDL-cholesterol (HDLC) were assayed at baseline. RESULTS: There were 108 CHD and 59 stroke endpoints over 3.9 years. The ApoB:A-I ratio at baseline was the lipoprotein variable most closely predicting CHD risk both by comparison of the hazard ratio for a 1 SD change or tertiles of frequency distribution. The areas under the receiver-operator curve for the ApoB:ApoA-I and the LDLC to HDLC [corrected] ratios, although not significantly different from each other, were greater (p = 0.0005 and p = 0.0125 respectively) than that of non-HDLC:HDLC. The 27% decrease in the ApoB:ApoA-I ratio on atorvastatin predicted a 32% (95% CI 5.4-51.2%) risk reduction in CHD, close to the 36% decrease observed. Neither the ApoB:ApoA-I nor any other lipoprotein concentration or ratio predicted the stroke outcome. CONCLUSIONS/ INTERPRETATION: Overall, the ApoB:ApoA-I ratio improved on the non-HDLC:HDLC ratio in predicting CHD, but, depending on the assessment chosen, its superiority over LDLC:HDLC may be marginal. The statin-induced decrease in stroke risk may not be lipoprotein mediated. TRIAL REGISTRATION: ClinicalTrials.gov NCT00327418. FUNDING: The study was supported by unrestricted grants from Diabetes UK, the Department of Health and Pfizer to the University of Manchester and to University College, London.
RCT Entities:
AIMS/HYPOTHESIS: Controversy surrounds whether the ratio of apolipoprotein B (ApoB) to apolipoprotein A-I (ApoA-I) is the best lipoprotein discriminator of CHD risk in non-diabetic populations, but the issue has never been investigated in type 2 diabetes. METHODS: In 2,627 participants without known vascular disease in the Collaborative AtorvastatinDiabetes Study, ApoB, ApoA-I, LDL-cholesterol (LDLC) and HDL-cholesterol (HDLC) were assayed at baseline. RESULTS: There were 108 CHD and 59 stroke endpoints over 3.9 years. The ApoB:A-I ratio at baseline was the lipoprotein variable most closely predicting CHD risk both by comparison of the hazard ratio for a 1 SD change or tertiles of frequency distribution. The areas under the receiver-operator curve for the ApoB:ApoA-I and the LDLC to HDLC [corrected] ratios, although not significantly different from each other, were greater (p = 0.0005 and p = 0.0125 respectively) than that of non-HDLC:HDLC. The 27% decrease in the ApoB:ApoA-I ratio on atorvastatin predicted a 32% (95% CI 5.4-51.2%) risk reduction in CHD, close to the 36% decrease observed. Neither the ApoB:ApoA-I nor any other lipoprotein concentration or ratio predicted the stroke outcome. CONCLUSIONS/ INTERPRETATION: Overall, the ApoB:ApoA-I ratio improved on the non-HDLC:HDLC ratio in predicting CHD, but, depending on the assessment chosen, its superiority over LDLC:HDLC may be marginal. The statin-induced decrease in stroke risk may not be lipoprotein mediated. TRIAL REGISTRATION: ClinicalTrials.gov NCT00327418. FUNDING: The study was supported by unrestricted grants from Diabetes UK, the Department of Health and Pfizer to the University of Manchester and to University College, London.
Authors: Ian Graham; Dan Atar; Knut Borch-Johnsen; Gudrun Boysen; Gunilla Burell; Renata Cifkova; Jean Dallongeville; Guy De Backer; Shah Ebrahim; Bjørn Gjelsvik; Christoph Herrmann-Lingen; Arno Hoes; Steve Humphries; Mike Knapton; Joep Perk; Silvia G Priori; Kalevi Pyorala; Zeljko Reiner; Luis Ruilope; Susana Sans-Menendez; Wilma Scholte Op Reimer; Peter Weissberg; David Wood; John Yarnell; Jose Luis Zamorano; Edmond Walma; Tony Fitzgerald; Marie Therese Cooney; Alexandra Dudina; Alex Vahanian; John Camm; Raffaele De Caterina; Veronica Dean; Kenneth Dickstein; Christian Funck-Brentano; Gerasimos Filippatos; Irene Hellemans; Steen Dalby Kristensen; Keith McGregor; Udo Sechtem; Sigmund Silber; Michal Tendera; Petr Widimsky; Jóse Luis Zamorano; Attila Altiner; Enzo Bonora; Paul N Durrington; Robert Fagard; Simona Giampaoli; Harry Hemingway; Jan Hakansson; Sverre Erik Kjeldsen; Mogens Lytken Larsen; Giuseppe Mancia; Athanasios J Manolis; Kristina Orth-Gomer; Terje Pedersen; Mike Rayner; Lars Ryden; Mario Sammut; Neil Schneiderman; Anton F Stalenhoef; Lale Tokgözoglu; Olov Wiklund; Antonis Zampelas Journal: Eur J Cardiovasc Prev Rehabil Date: 2007-09
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Authors: B A Griffin; A M Minihane; N Furlonger; C Chapman; M Murphy; D Williams; J J Wright; C M Williams Journal: Clin Sci (Lond) Date: 1999-09 Impact factor: 6.124
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