Data presented in a poster session at the American College of Cardiology annual scientific sessions, in Washington, DC, suggest that a diagnostic strategy using nuclear magnetic resonance technologies can improve cholesterol management and reduce incidence of cardiovascular events, especially among patients with diabetes and those on statin therapy.
The study data show that patients managed to a target LDL particle (LDL-P) number achieved a 22% to 25% greater reduction in the risk of cardiovascular events over a three-year period compared to patients who attained LDL cholesterol (LDL-C) targets.
Data from the study, “Comparison of Cardiovascular Events between Patients Achieving Low-Density Lipoprotein Particle Targets and Patients Achieving Low-Density Lipoprotein Cholesterol Targets,” represented findings derived from a real-world sample of commercially insured patients who were at high risk of cardiovascular events, including patients with coronary heart disease and diabetes mellitus. Measurement of subjects’ cholesterol levels were made using the NMR LipoProfile test by study sponsor LipoScience Inc, a company that is pioneering a new field of personalized NMR diagnostics to advance the quality of patient care in cardiovascular, metabolic, and other diseases.
The investigators found that patients who achieved target LDL-P levels (<1000 nmol/L) received more aggressive lipid-lowering treatment than those reaching target LDL-C concentrations (<100 mg/dL). Those treatment differences were associated with better outcomes (as measured by the reduction in cardiovascular event rates) over one to three years of follow-up.
The study was sponsored by LipoScience and jointly designed by LipoScience and HealthCore Inc, the clinical outcomes research subsidiary of WellPoint Inc, with clinical input from Terry A Jacobson, MD, professor of medicine at Emory University, and Peter P Toth, MD, PhD, director of preventive cardiology at CGH Medical Center, Sterling, Ill. The NMR LipoProfile test is LipoScience’s first proprietary test, and the only FDA-cleared blood test that directly quantifies LDL particles and provides physicians and their patients with actionable information to personalize management of heart disease.
“These new data add to the growing body of evidence suggesting that NMR measurement of LDL particle number, when used in conjunction with other lipid measurements, is a valuable cardiovascular risk management tool,” commented Jacobson, the lead author of the study. “Due to the wide variance in the cholesterol content of LDL particles among individuals, measurements of LDL cholesterol and LDL particle number frequently disagree, especially in patients with insulin resistance and those treated with lipid-lowering therapies. When a disagreement between LDL-P and LDL-C is present, quantification of LDL particle number is a more clinically reliable measure of LDL and of treatment outcomes than measurement of LDL cholesterol.”
Jacobson and colleagues analyzed data from more than 4,000 high-risk patients (over 2,000 with LDL-P < 1000 nmol/L and over 2,000 with LDL-C < 100 mg/dL) selected from the HealthCore Integrated Research Database who were followed for as long as three years. Those who achieved the LDL-P target of <1000 nmol/L were more likely to receive higher-potency statin medications at baseline, compared to patients whose LDL-P levels were not measured but who achieved LDL-C concentrations below 100 mg/dL. The risk of a cardiovascular event was 22% to 25% lower in the LDL-P target group than in the LDL-C target group over one to three years of follow-up.
“The HealthCore data add an important, real-world, analysis to the ongoing discussion of how best to optimize individual patient management,” said William C. Cromwell, MD, chief medical officer of LipoScience. “These findings are consistent with the recommendations of various expert panels and organizations such as the National Lipid Association, the American Association for Clinical Chemistry, and the American Association of Clinical Endocrinologists, each of which advocates the use of LDL-P as a target of therapy in managing at-risk patients. We hope the findings encourage greater adoption by clinicians to manage their patients to an LDL-P target to reduce CVD events.”
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