Abstract 5051: Alteration of Atherogenic Lipoproteins by Statin Therapy in Patients With Diabetes in a Large Pooled Clinical Trial Database
Reducing LDL-C to current goals may still leave an excess of atherogenic lipoproteins as reflected in apolipoprotein (Apo) B levels. Apo B provides a measure of atherogenic particles in blood, a predictor of CHD events. Patients with diabetes mellitus (DM) are at increased CHD risk and warrant intensive therapy. Recent joint ADA and ACCF guidelines recommend reducing Apo B to <90 mg/dL in high-risk patients and optionally to <80 mg/dL in those at very high risk. We examined the effect of statin therapy on the relationship between these Apo B targets and LDL-C and non-high-density lipoprotein cholesterol (non-HDL-C) in high-risk patients with and without DM. A pooled analysis of data in the rosuvastatin clinical development program was used to identify 12,269 high CHD risk patients who were examined at baseline and after therapy with rosuvastatin, atorvastatin or simvastatin. Apo B was compared with LDL-C and non-HDL-C both at baseline and on therapy using linear regression. At baseline, Apo B target of 90 mg/dL in DM was equivalent to LDL-C of 115 mg/dL and non-HDL-C of 139.8 mg/dL, which was slightly higher than for non-DM (Table⇓). Achieving Apo B of 90 mg/dL or 80 mg/dL required much more aggressive LDL-C and non-HDL-C goals on statin therapy. Of note, this effect and resultant targets were very similar in DM and non-DM. Achieving with statin therapy Apo B of 90 mg/dL in high-risk patients requires LDL-C target of ~80 mg/dL and non-HDL-C target of ~108 mg/dL. The on-therapy LDL-C target (<70 mg/dL) and non-HDL-C target (<100 mg/dL) for very high risk patients correspond to Apo B target of 80 mg/dL. During statin therapy, Apo B correlated well with LDL-C (R2=0.77– 0.81) and very well with non-HDL-C (R2=0.88 – 0.90). Non-HDL-C may be a useful surrogate for direct Apo B measurement. High-risk DM and non-DM patients require lower LDL-C and non-HDL-C targets during statin therapy in order to reduce Apo B to the recommended level.