title: Predictive value of remnant lipoprotein for cardiovascular events in patients with coronary artery disease after achievement of LDL-cholesterol goals.
abstract: OBJECTIVE
  Triglycerides-rich lipoproteins are related to residual cardiovascular risk in patients on lipid-lowering treatment who achieve low-density lipoprotein cholesterol (LDL-C) goals. This study examined the predictive value of remnant lipoprotein levels for cardiovascular events in patients with coronary artery disease (CAD) with LDL-C levels <100mg/dL on lipid-lowering therapy.
  
  
  METHODS
  Serum levels of remnant lipoproteins (remnant-like lipoprotein particles cholesterol; RLP-C) were measured by an immunoseparation method in 560 patients with CAD who had LDL-C levels <100mg/dL on lipid-lowering therapy, including statin (58%), fibrate (13%) or diet only (29%). All the patients were followed prospectively for a period of ≤ 36 months or until occurrence of one of the following events: cardiac death, non fatal myocardial infarction, unstable angina requiring coronary revascularization, or ischemic stroke.
  
  
  RESULTS
  During a mean follow-up period of 33 months, 40 events occurred. Stepwise multivariate Cox proportional hazard analysis showed that RLP-C was a significant predictor of cardiovascular events after adjustment for known risk factors and lipid variables including triglycerides, non-high-density lipoprotein (HDL)-C, and total apolipoprotein B (HR 1.53, 95% CI 1.35-1.97, p<0.01). The c-statistics showed that addition of RLP-C had a greater incremental effect on the predictive value of conventional risk factors than addition of non-HDL-C or total apolipoprotein B.
  
  
  CONCLUSIONS
  RLP-C was superior to non-HDL-C for predicting cardiovascular events in CAD patients with LDL-C levels <100mg/dL on lipid-lowering treatment. Remnant lipoprotein may therefore be an important target for residual risk reduction after LDL-C goals on lipid lowering therapy.
authors: University of Yamanashi, Internal Medicine II, Chuo, Japan.
authors: Takamitsu
authors: T
authors: Nakamura
authors: Jun-ei
authors: JE
authors: Obata
authors: Mitsumasa
authors: M
authors: Hirano
authors: Yoshinobu
authors: Y
authors: Kitta
authors: Daisuke
authors: D
authors: Fujioka
authors: Yukio
authors: Y
authors: Saito
authors: Ken-ichi
authors: K
authors: Kawabata
authors: Kazuhiro
authors: K
authors: Watanabe
authors: Yosuke
authors: Y
authors: Watanabe
authors: Hideto
authors: H
authors: Mishina
authors: Kiyotaka
authors: K
authors: Kugiyama