© 2000 American Heart Association, Inc.
Atherosclerosis and Lipoproteins |
Apolipoprotein Concentrations During Treatment and Recurrent Coronary Artery Disease Events
From the Department of Cardiology (J.E.R.v.L., E.E.v.d.W.) and Department of Medical Statistics (A.H.Z.), Leiden University Medical Center, Leiden; Department of Internal Medicine (H.T.W., D.W.E.), University Medical Center Utrecht, Utrecht and Oosterschelde Hospital (H.W.O.R.v.L), Goes, the Netherlands. Correspondence to Ernst E. van der Wall, MD, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
Abstract—The effect of
untreated total cholesterol (TC) and low density
lipoprotein cholesterol (LDL-C) as
cardiovascular risk factors in both primary and
secondary prevention has been extensively investigated. The predictive
value of on-treatment lipid and apolipoprotein levels on subsequent
cardiovascular events is as yet uncertain. Eight
hundred forty-eight patients (675 men and 173 women) with
angiographically proven coronary artery disease (CAD) who
received effective statin therapy (
30% decrease of baseline TC) were
studied. We analyzed the predictive value of on-treatment
levels of TC, LDL-C, triglycerides (TG), apolipoprotein A-I
(apoA-I) and apolipoprotein B (apoB) on subsequent myocardial
infarction (MI) and all cause mortality. On-treatment LDL-C levels were
2.55±0.55 mmol/L and 2.58±0.62 mmol/L for men and women
respectively. Age-adjusted Cox regression analysis showed that
only on-treatment apoA-I was predictive for future CAD events in both
men and women, whereas on-treatment HDL-C was exclusively predictive in
women. On-treatment apoB levels were predictive for recurrent CAD
events in the total population but not after separate analysis
for men and women. On-treatment levels of TC, LDL-C, and TG did not
predict subsequent events. Multivariate
analysis showed that on-treatment apoA-I and apoB were the only
significant predictors for future cardiovascular
events. On-treatment levels of TC, LDL-C, and TG were no longer
associated with increased risk of recurrent
cardiovascular events in CAD patients treated to target
levels, which justifies the current guidelines. However, on-treatment
levels of apoB and in particular apoA-I (and HDL-C in women) were
significantly predictive for MI and all-cause mortality and may
therefore be more suitable for cardiovascular risk
assessment in this population.
Key Words: lipids • apolipoproteins • risk factors • coronary disease
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