CHD Event Associations of NMR LDL Particle Number

CHD Event Associations of NMR LDL Particle Number (LDL-P) versus LDL Cholesterol (LDL-C)

LDL Particle Number and Risk of Future Cardiovascular Disease in the Framingham Offspring Study – Implications for LDL Management Wm. C. Cromwell, James D. Otvos et al Journal of Clinical Lipidology: Publication date: December 12, 2007 • Objective: To compare the ability of alternative measures of LDL to provide CVD risk discrimination at relatively low potential target levels. The hypothesis that non-HDL-C predicts risk better than LDL-C was also examined. • Conclusion: “In a large community-based sample, LDL-P was a more sensitive indicator of low CVD risk than either LDL-C or non-HDL-C, suggesting a potential clinical role for LDL-P as a goal of LDL management. ” • Study population: 3066 middle-aged white participants (53% women) without CVD in the Framingham Offspring cohort. The outcome measure was the first CVD event. 16 year follow-up.

Incidence of Cardiovascular disease events (Table 4) • “Subjects with a low level of LDL-P (<25 th percentile) had a lower CVD event rate (59 events per 1000 person years) than those with an equivalently low level of LDL-C or non HDL-C(81 and 74 events per 1000 person years respectively). ” • LDL-C – Median (mg/dl) = 92 – No. Events = 75 – Event rate per 1000 person-years = 81 • LDL-P – Median (nmol/L) = 967 – No. Events = 55 – Event rate per 1000 person-years = 59 • Low LDL-P was associated with 27% fewer CVD events than an equivalently low level of LDL-C.

Statistical Relationships between alternative measures of LDL and CVD Incidence (Table 3) • “LDL-P was strongly associated with CVD risk in both men and women (p <0. 0001)”. • “When data for men and women were combined, LDL-P was approximately twice as strongly related to CVD incidence as LDL-C”.

CHD Event Associations of NMR LDL Particle Number (LDL-P) versus LDL Cholesterol (LDL-C) • Lower CVD event rates were associated with low numbers of LDL particles regardless of LDL cholesterol content • Higher CVD event rates were associated with high numbers of LDL particles regardless of LDL cholesterol content • The highest event rate was associated with high numbers of LDL particles and Low LDL cholesterol content