title: Cardiovascular risk in patients achieving low-density lipoprotein cholesterol and particle targets.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors: 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. Electronic address: Peter.Toth@cghmc.com.
authors: Peter P
authors: PP
authors: Toth
authors: HealthCore, Inc., 800 Delaware Avenue, Fifth Floor, Wilmington, DE 19801, USA. Electronic address: mgrabner@healthcore.com.
authors: Michael
authors: M
authors: Grabner
authors: HealthCore, Inc., 800 Delaware Avenue, Fifth Floor, Wilmington, DE 19801, USA. Electronic address: rpunekar@healthcore.com.
authors: Rajeshwari S
authors: RS
authors: Punekar
authors: HealthCore, Inc., 800 Delaware Avenue, Fifth Floor, Wilmington, DE 19801, USA. Electronic address: rquimbo@healthcore.com.
authors: Ralph A
authors: RA
authors: Quimbo
authors: HealthCore, Inc., 800 Delaware Avenue, Fifth Floor, Wilmington, DE 19801, USA. Electronic address: mcziraky@healthcore.com.
authors: Mark J
authors: MJ
authors: Cziraky
authors: Emory University, 49 Jesse Hill Jr Drive SE, Atlanta, GA 30303, USA. Electronic address: tjaco02@emory.edu.
authors: Terry A
authors: TA
authors: Jacobson
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000209:etiology*; D008078:Cholesterol, LDL / Q000097:blood*; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008077:Lipoproteins, LDL / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010316:Particle Size; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D014481:United States / Q000453:epidemiology
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D008077:Lipoproteins, LDL
keywords: Cardiovascular disease prevention; Comparative effectiveness; Health services research; Lipoproteins; Outcomes; Risk factors