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July 11, 2012

Lipid Parameters and Cardiovascular Events in Patients Taking Statins

Author Affiliations

Author Affiliations: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland (smart100@jhmi.edu).

JAMA. 2012;308(2):131-133. doi:10.1001/jama.2012.6614

To the Editor: The meta-analysis by Dr Boekholdt and colleagues1 assessed the associations of multiple lipid parameters with cardiovascular events in patients receiving statins. Levels of low-density lipoprotein cholesterol (LDL-C), non–high-density lipoprotein cholesterol (non–HDL-C), and apolipoprotein B (apoB) were each associated with risk for major cardiovascular events and the strength of association was greatest for non–HDL-C. Levels of LDL-C (the current primary therapeutic goal in the National Cholesterol Education Program guidelines2,3) did not add to risk prediction after accounting for non–HDL-C goal attainment. For example, the authors reported that patients treated with statins who attained the goal of a non–HDL-C level of less than 130 mg/dL, but not the related goal of a LDL-C level of less than 100 mg/dL, did not have increased risk compared with those attaining both goals (hazard ratio [HR], 1.01 [95% CI, 0.92-1.12]; P = .85). In contrast, patients achieving the LDL-C goal but not the non–HDL-C goal had increased risk (HR, 1.32 [95% CI, 1.17-1.50]; P <.001).

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