Author Affiliations: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (email@example.com).
To the Editor: Dr Boekholdt and colleagues1 performed a meta-analysis of 8 trials to compare the strengths of the association of levels of apoB, non–HDL-C, and LDL-C while patients were taking statins with risk of future cardiovascular events. The authors should have acknowledged that statins reduced apoB to a lesser extent than lipoproteins, which has been reported before2 and may have contributed to the modest superiority of non–HDL-C, given that HRs per SD change in each factor were evaluated. Due to variations in atherogenic particle cholesterol content, the risks of non–HDL-C and apoB can differ in subsets of individuals even if they are fairly similar for the overall population.3 To address this issue, it would be important to know whether patients with discordantly elevated apoB levels compared with non–HDL-C levels (evaluated by achieved percentiles or threshold targets of apoB) were at residual high cardiovascular risk.
Brook RD, Rubenfire M. Lipid Parameters and Cardiovascular Events in Patients Taking Statins. JAMA. 2012;308(2):131-133. doi:10.1001/jama.2012.6616