Toth Peter P, Grabner Michael, Punekar Rajeshwari S, Quimbo Ralph A, Cziraky Mark J, Jacobson Terry A
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.
HealthCore, Inc., 800 Delaware Avenue, Fifth Floor, Wilmington, DE 19801, USA.
Atherosclerosis. 2014 Aug;235(2):585-91. doi: 10.1016/j.atherosclerosis.2014.05.914. Epub 2014 May 22.
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.
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.
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).
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.
先前的研究表明，低密度脂蛋白颗粒数量（LDL-P）可能是比低密度脂蛋白胆固醇（LDL-C）更好的指导降低LDL治疗的工具。本研究利用真实世界数据有两个目标：[1]确定不同LDL-P阈值下冠心病（CHD）的发病率；[2]比较达到相当低的LDL-P或LDL-C水平的患者中CHD/中风事件。
对从HealthCore综合研究数据库（SM）中识别出的高危患者进行索赔分析。比较了达到LDL-P<1000 nmol/L或LDL-C<100 mg/dL的队列中LDL水平对风险的影响。对队列进行匹配以平衡人口统计学和合并症差异。
在15569例有LDL-P测量值的患者中，LDL-P水平每升高100 nmol/L，CHD事件风险增加4%（风险比1.04；95%置信区间1.02-1.05，p<.0001）。比较分析包括2094例随访≥12个月、1242例随访≥24个月和705例随访≥36个月的匹配患者。在所有时间段，进行LDL-P测量的患者比LDL-C队列中的患者更有可能接受强化降脂治疗，且CHD/中风风险更低（风险比：0.76；95%置信区间：0.61-0.96；在12个月时）。
在这个商业保险患者的真实世界样本中，较高的LDL-P水平与CHD风险增加相关。此外，LDL-P<1000 nmol/L的高危患者比LDL-C<100 mg/dL的患者接受了更积极的降脂治疗，并且这些血脂和治疗管理方面的差异与12个月、24个月和36个月随访期间CHD/中风事件的减少相关。
