Abstract 5148: Lipoprotein Particles Identify Residual Risk after Lipid Goal Achievement in Patients with the Metabolic Syndrome
Introduction: Low-density lipoprotein particle concentration (LDL-P) predicts CHD risk more accurately than does LDL cholesterol (LDL-C). Patients with metabolic syndrome (MetS) and dyslipidemia may have an excess of LDL-P, even with relatively normal LDL-C. The effects of statins on LDL-P and LDL-C were examined in a secondary analysis of the COmparative study with rosuvastatin in subjects with METabolic Syndrome (COMETS).
Methods: Randomized patients (N = 401; LDL-C >130 mg/dL and 10-year CHD risk >10%) received, from baseline to week 6, double-blind rosuvastatin (RSV) 10 mg/d, atorvastatin (ATV) 10 mg/d, or placebo. From week 6 to week 12, patients who had been randomized to RSV 10 mg/d or placebo were treated with RSV 20 mg/d; those previously randomized to ATV 10 mg/d took ATV 20 mg/d. LDL-C was determined by β-quantification; LDL-P was measured by NMR spectroscopy; the last observation was carried forward if a final end point measurement was unavailable. Goal attainment for LDL-C <100 mg/dL (<20th percentile, NHANES III), LDL-P <1000 nmol/L (<20th percentile, Multi-Ethnic Study of Atherosclerosis [MESA]), and LDL-P <1300 nmol/L (50th percentile, MESA) was assessed.
Results: The majority of patients achieved LDL-C <100 mg/dL (61%) and LDL-P <1300 nmol/L (57%) after 6 weeks of RSV treatment, or after 12 weeks with either statin (55%– 80%) (Figure⇓). Few patients (12%–27%) reached LDL-P <1000 nmol/L.
Conclusions: In MetS patients, LDL-C goal attainment with statins may underestimate residual risk of CHD. Managing such patients to LDL-P goals may lead to more effective implementation of lipid-lowering therapy and may reduce residual risk of CHD nearer to optimal levels.