Abstract 20171: Discordance Between Apolipoprotein B, LDL-C and Non-HDL-C in Diabetic Patients Presenting With Acute Coronary Syndrome on Statin Therapy
Background: Patients hospitalized for possible acute coronary syndrome (ACS) often present with LDL-C and non-HDL-C at guideline-based goal. Some have suggested apolipoprotein B (apoB) better predicts cardiovascular events over traditional lipids, and may identify residual risk in statin treated diabetic patients. The discordance between LDL-C, non-HDL-C and apoB levels in statin-treated diabetic patients presenting with ACS is unknown.
Method: We performed a retrospective review of patients presenting to our emergency room from January, 2012 to January 2013 with chest pain and abnormal troponin. We identified those with diabetes and on statin therapy. Per hospital protocol, apoB, non-HDL-C and LDL-C were all measured at presentation. Degree of discordance was quantified by kappa analysis.
Results: Among 665 patients (62 +_ 13.9 years, 55.5% men) included in this population, 302 (51%) were on statin at admission, 210 (31%) were diabetic and 130 diabetics were on statins. Results based on defined LDL(C), Non-HDL, and Apo B cut points are shown table 1.
Conclusion: There is significant discordance in statin-treated diabetic subjects presenting with ACS while meeting guideline-based lipid goals. This large discordance may reflect under treatment and explain this observed residual risk. Further studies are needed to determine
whether intensification of lipid lowering therapy targeting apoB in diabetics would reduce cardiovascular events.
Author Disclosures: H. Alwash: None. J. Lee: None. Z. Qian: None. P. Joshi: None. R. Pitts: None. S. Rinehart: None. J. Miller: None.
- © 2014 by American Heart Association, Inc.