title: Plasma lipoproteins and apolipoproteins as predictors of cardiovascular risk and treatment benefit in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER).
abstract: BACKGROUND
  Statins are important in vascular disease prevention in the elderly. However, the best method of selecting older patients for treatment is uncertain. We assessed the role of plasma lipoproteins as predictors of risk and of treatment benefit in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER).
  
  
  RESULTS
  The association of LDLc and HDLc with risk was examined in the 5804 70- to 82-year-old subjects of PROSPER. Baseline LDLc showed no relation to risk of the primary end point in the placebo group (P=0.27), nor did on-treatment LDLc in the pravastatin group (P=0.12). HDLc was inversely associated with risk in subjects on placebo (P=0.0019) but not in those on pravastatin (P=0.24). Risk reduction on pravastatin treatment was unrelated to baseline LDLc (P=0.38) but exhibited a significant interaction with HDLc (P=0.012). Subjects in the lowest 2 quintiles of HDLc (<1.15 mmol/L) had a risk reduction of 33% (hazard ratio, 0.67; 95% confidence limits, 0.55, 0.81; P<0.0001), whereas those with higher HDLc showed no benefit (RR, 1.06; 95% confidence limits, 0.88, 1.27; P=0.53). During follow-up, there was no relation between achieved level of LDLc or HDLc and risk. However, the change in the LDLc/HDLc ratio on statin treatment appeared to account for the effects of therapy.
  
  
  CONCLUSIONS
  In people >70 years old, HDLc appears to be a key predictor of risk and of treatment benefit. Findings in PROSPER suggest that statin therapy could usefully be targeted to those with HDLc <1.15 mmol/L or an LDLc/HDLc ratio >3.3.
authors.affiliation: Department of Vascular Biochemistry, University of Glasgow, Glasgow, Scotland. chris.packard@clinmed.gla.ac.uk
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Packard
authors.forename: Ian
authors.initials: I
authors.lastname: Ford
authors.forename: Michele
authors.initials: M
authors.lastname: Robertson
authors.forename: James
authors.initials: J
authors.lastname: Shepherd
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Blauw
authors.forename: Michael B
authors.initials: MB
authors.lastname: Murphy
authors.forename: Edward L E M
authors.initials: EL
authors.lastname: Bollen
authors.forename: Brendan M
authors.initials: BM
authors.lastname: Buckley
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Cobbe
authors.forename: Allan
authors.initials: A
authors.lastname: Gaw
authors.forename: Michael
authors.initials: M
authors.lastname: Hyland
authors.forename: J Wouter
authors.initials: JW
authors.lastname: Jukema
authors.forename: Adriaan M
authors.initials: AM
authors.lastname: Kamper
authors.forename: Peter W
authors.initials: PW
authors.lastname: Macfarlane
authors.forename: Ivan J
authors.initials: IJ
authors.lastname: Perry
authors.forename: David J
authors.initials: DJ
authors.lastname: Stott
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Sweeney
authors.forename: Cillian
authors.initials: C
authors.lastname: Twomey
authors.forename: Rudi G J
authors.initials: RG
authors.lastname: Westendorp
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001053:Apolipoproteins / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015994:Incidence; D008074:Lipoproteins / Q000097:blood*; D017035:Pravastatin / Q000627:therapeutic use*; D018570:Risk Assessment
chemical_list: D001053:Apolipoproteins; D015415:Biomarkers; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008074:Lipoproteins; D017035:Pravastatin