title: Achieving secondary prevention low-density lipoprotein particle concentration goals using lipoprotein cholesterol-based data.
abstract: BACKGROUND
  Epidemiologic studies suggest that LDL particle concentration (LDL-P) may remain elevated at guideline recommended LDL cholesterol goals, representing a source of residual risk. We examined the following seven separate lipid parameters in achieving the LDL-P goal of <1000 nmol/L goal for very high risk secondary prevention: total cholesterol to HDL cholesterol ratio, TC/HDL, <3; a composite of ATP-III very high risk targets, LDL-C<70 mg/dL, non-HDL-C<100 mg/dL and TG<150 mg/dL; a composite of standard secondary risk targets, LDL-C<100, non-HDL-C<130, TG<150; LDL phenotype; HDL-C ≥ 40; TG<150; and TG/HDL-C<3.
  
  
  METHODS
  We measured ApoB, ApoAI, ultracentrifugation lipoprotein cholesterol and NMR lipoprotein particle concentration in 148 unselected primary and secondary prevention patients.
  
  
  RESULTS
  TC/HDL-C<3 effectively discriminated subjects by LDL-P goal (F = 84.1, p<10(-6)). The ATP-III very high risk composite target (LDL-C<70, nonHDL-C<100, TG<150) was also effective (F = 42.8, p<10(-5)). However, the standard secondary prevention composite (LDL-C<100, non-HDL-C<130, TG<150) was also effective but yielded higher LDL-P than the very high risk composite (F = 42.0, p<10(-5)) with upper 95% confidence interval of LDL-P less than 1000 nmol/L. TG<150 and TG/HDL-C<3 cutpoints both significantly discriminated subjects but the LDL-P upper 95% confidence intervals fell above goal of 1000 nmol/L (F = 15.8, p = 0.0001 and F = 9.7, p = 0.002 respectively). LDL density phenotype neared significance (F = 2.85, p = 0.094) and the HDL-C cutpoint of 40 mg/dL did not discriminate (F = 0.53, p = 0.47) alone or add discriminatory power to ATP-III targets.
  
  
  CONCLUSIONS
  A simple composite of ATP-III very high risk lipoprotein cholesterol based treatment targets or TC/HDL-C ratio <3 most effectively identified subjects meeting the secondary prevention target level of LDL-P<1000 nmol/L, providing a potential alternative to advanced lipid testing in many clinical circumstances.
authors.affiliation: Department of Medicine, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Simon C
authors.initials: SC
authors.lastname: Mathews
authors.forename: Jaya
authors.initials: J
authors.lastname: Mallidi
authors.forename: Krishnaji
authors.initials: K
authors.lastname: Kulkarni
authors.forename: Peter P
authors.initials: PP
authors.lastname: Toth
authors.forename: Steven R
authors.initials: SR
authors.lastname: Jones
mesh_terms: D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood*; D003324:Coronary Artery Disease / Q000097:blood / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D016491:Peripheral Vascular Diseases / Q000097:blood / Q000517:prevention & control; D012372:ROC Curve; D055502:Secondary Prevention
chemical_list: D008078:Cholesterol, LDL