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20th World Congress on Heart Disease



Samia Mora, M.D., Brigham and Women's Hospital, Boston, MA, USA


Objectives: Cardiovascular disease (CVD) can occur in individuals with low LDL-cholesterol (LDL-c). We investigated whether detailed measures of LDL subfractions and other lipoproteins can be used to assess CVD risk in a population with both low LDL-c and high C-reactive protein that was randomized to high-intensity statin or placebo.

Methods and Results: In 11,186 JUPITER participants, we tested whether lipids, apolipoproteins, and ion mobility (IM)-measured particle concentrations at baseline and after random allocation to rosuvastatin 20 mg/d or placebo were associated with first CVD events (n=307) or CVD/all-cause death (n=522). In placebo-allocated participants, baseline LDL-c was not associated with CVD (adjusted HR per SD, 1.03, 95% CI 0.89-1.20). In contrast, associations with CVD events were observed for baseline non-HDL-cholesterol (non-HDL-c: 1.18, 1.02-1.37), apolipoprotein B (apoB: 1.28, 1.11-1.49), and IM-measured non-HDL particles (non-HDL-p: 1.19, 1.05-1.36) and LDL particles (LDL-p: 1.21, 1.06-1.38). Association with CVD events was also observed for several LDL and VLDL subfractions, but not for IM-measured HDL subfractions. In statin-allocated participants, CVD events were associated with on-treatment LDL-c, non-HDL-c, and apoB; these were also associated with CVD/all-cause death, as were several LDL and VLDL subfractions albeit with a pattern of association that differed from the baseline risk.

Conclusions: In JUPITER, baseline LDL-c was not associated with CVD events, in contrast with significant associations for non-HDL-c and atherogenic particles: apoB and IM-measured non-HDL-p, LDL-p, and select subfractions of VLDL-p and LDL-p. During high-intensity statin therapy, on-treatment levels of LDL-c and atherogenic particles were associated with residual risk of CVD/all-cause death.



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