Peter P Toth1, Michael Grabner2, Rajeshwari S Punekar3, Ralph A Quimbo4, Mark J Cziraky5, Terry A Jacobson6. 1. CGH Medical Center, 100 E Le Fevre Rd, Sterling, IL 61081, USA; University of Illinois School of Medicine, 1 Illini Dr, Peoria, IL 61605, USA. Electronic address: Peter.Toth@cghmc.com. 2. HealthCore, Inc., 800 Delaware Avenue, Fifth Floor, Wilmington, DE 19801, USA. Electronic address: mgrabner@healthcore.com. 3. HealthCore, Inc., 800 Delaware Avenue, Fifth Floor, Wilmington, DE 19801, USA. Electronic address: rpunekar@healthcore.com. 4. HealthCore, Inc., 800 Delaware Avenue, Fifth Floor, Wilmington, DE 19801, USA. Electronic address: rquimbo@healthcore.com. 5. HealthCore, Inc., 800 Delaware Avenue, Fifth Floor, Wilmington, DE 19801, USA. Electronic address: mcziraky@healthcore.com. 6. Emory University, 49 Jesse Hill Jr Drive SE, Atlanta, GA 30303, USA. Electronic address: tjaco02@emory.edu.
Abstract
OBJECTIVES: Previous research suggests that LDL particle number (LDL-P) may be a better tool than LDL cholesterol (LDL-C) to guide LDL-lowering therapy. Using real-world data, this study has two objectives: [1] to determine the incidence of CHD across LDL-P thresholds; and [2] to compare CHD/stroke events among patients achieving comparably low LDL-P or LDL-C levels. METHODS: A claims analysis was conducted among high-risk patients identified from the HealthCore Integrated Research Database(SM). The impact of LDL levels on risk was compared across cohorts who achieved LDL-P <1000 nmol/L or LDL-C <100 mg/dL. Cohorts were matched to balance demographic and comorbidity differences. RESULTS: Among 15,569 patients with LDL-P measurements, the risk of a CHD event increased by 4% for each 100 nmol/L increase in LDL-P level (HR 1.04; 95% CI 1.02-1.05, p < .0001). The comparative analysis included 2,094 matched patients with ≥12 months of follow-up, 1,242 with ≥24 months and 705 with ≥36 months. At all time periods, patients undergoing LDL-P measurement were more likely to receive intensive lipid-lowering therapy and had a lower risk of CHD/stroke than those in the LDL-C cohort (HR: 0.76; 95% CI: 0.61-0.96; at 12 months). CONCLUSIONS: In this real-world sample of commercially insured patients, higher LDL-P levels were associated with increased CHD risk. Moreover, high-risk patients who achieved LDL-P <1000 nmol/L received more aggressive lipid-lowering therapy than patients achieving LDL-C <100 mg/dL, and these differences in lipids and therapeutic management were associated with a reduction in CHD/stroke events over 12, 24 and 36 months follow-up.
OBJECTIVES: Previous research suggests that LDL particle number (LDL-P) may be a better tool than LDL cholesterol (LDL-C) to guide LDL-lowering therapy. Using real-world data, this study has two objectives: [1] to determine the incidence of CHD across LDL-P thresholds; and [2] to compare CHD/stroke events among patients achieving comparably low LDL-P or LDL-C levels. METHODS: A claims analysis was conducted among high-risk patients identified from the HealthCore Integrated Research Database(SM). The impact of LDL levels on risk was compared across cohorts who achieved LDL-P <1000 nmol/L or LDL-C <100 mg/dL. Cohorts were matched to balance demographic and comorbidity differences. RESULTS: Among 15,569 patients with LDL-P measurements, the risk of a CHD event increased by 4% for each 100 nmol/L increase in LDL-P level (HR 1.04; 95% CI 1.02-1.05, p < .0001). The comparative analysis included 2,094 matched patients with ≥12 months of follow-up, 1,242 with ≥24 months and 705 with ≥36 months. At all time periods, patients undergoing LDL-P measurement were more likely to receive intensive lipid-lowering therapy and had a lower risk of CHD/stroke than those in the LDL-C cohort (HR: 0.76; 95% CI: 0.61-0.96; at 12 months). CONCLUSIONS: In this real-world sample of commercially insured patients, higher LDL-P levels were associated with increased CHD risk. Moreover, high-risk patients who achieved LDL-P <1000 nmol/L received more aggressive lipid-lowering therapy than patients achieving LDL-C <100 mg/dL, and these differences in lipids and therapeutic management were associated with a reduction in CHD/stroke events over 12, 24 and 36 months follow-up.
Authors: Nathan D Wong; Yanglu Zhao; Ruben G W Quek; Roger S Blumenthal; Matthew J Budoff; Mary Cushman; Parveen Garg; Veit Sandfort; Michael Tsai; J Antonio G Lopez Journal: J Clin Lipidol Date: 2017-06-30 Impact factor: 4.766
Authors: Naomi J Rankin; David Preiss; Paul Welsh; Karl E V Burgess; Scott M Nelson; Debbie A Lawlor; Naveed Sattar Journal: Atherosclerosis Date: 2014-09-30 Impact factor: 5.162
Authors: Michael J Koren; Dean Kereiakes; Ray Pourfarzib; Deborah Winegar; Poulabi Banerjee; Sara Hamon; Corinne Hanotin; James M McKenney Journal: J Am Heart Assoc Date: 2015-11-19 Impact factor: 5.501
Authors: Ruben N Eppinga; Minke H T Hartman; Dirk J van Veldhuisen; Chris P H Lexis; Margery A Connelly; Erik Lipsic; Iwan C C van der Horst; Pim van der Harst; Robin P F Dullaart Journal: PLoS One Date: 2016-01-25 Impact factor: 3.240
Authors: Nasir H Bhanpuri; Sarah J Hallberg; Paul T Williams; Amy L McKenzie; Kevin D Ballard; Wayne W Campbell; James P McCarter; Stephen D Phinney; Jeff S Volek Journal: Cardiovasc Diabetol Date: 2018-05-01 Impact factor: 9.951