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Atherothrombotic Outcomes When Lipid Target Goals Are Not Met
322
Study Funding: None Background/Synopsis: Changes in LDL-cholesterol versus changes in the Cholesterol Retention Fraction (CRF) as regards plaque progression versus non-progression in the Program on the Surgical Control of Hyperlipidemia (POSCH) were compared. No one whose CRF increased had plaque nonprogression and no one whose CRF decreased had plaque progression. If LDL remained the same or increased, plaque regression occurred in 28% of cases and if LDL decreased, plaque progression occurred in 11% of cases. Hence, the CRF is a superior predictor of plaque changes than LDL. Objective/Purpose: To show that the CRF is superior to LDL in predicting changes in plaque dynamics in response to therapy. Methods: The POSCH database was examined to determine plaque progression versus plaque non-progression in terms of changes in LDL or CRF. CRF is defined as (LDLHDL)/LDL. The POSCH study utilized a low cholesterol diet, with some patients receiving a partial ileal bypass as active treatment. Lipid profiles wee obtained at baseline and one year; angiograms, at one and three years. All patients had sustained an acute myocardial infarction prior to trial entry. Results: No one whose CRF increased had plaque nonprogression and no one whose CRF decreased had plaque progression. In patients whose LDL rose or did not change, plaque non-progression occurred in 37/134 (28%) of cases; in patients whose LDL fell, plaque progression occurred in 66/597 (11%) of cases. Conclusion: The CRF is superior to LDL in predicting plaque changes in response to therapy in POSCH. 130 Atherothrombotic Outcomes When Lipid Target Goals Are Not Met W. E. (William E.) Feeman Jr., MD, (Bowling Green, OH)
Lead Author’s Financial Disclosures: None Study Funding: None Background/Synopsis: Dyslipidemia is a leading cause of atherothrombotic disease (ATD) its treatment therefore should be targeted to achieving maximal reduction of ATD events. The recent American Heart Association/American Academy of Cardiology (AHA/ACC) guidelines have abandoned target lipid goals of therapy. The database of an outcomes study (TexCAPS/AFCAPS) will be examined and will show that when specified treatment goals are met, beneficial effects are maximized, but when they are not met, such benefits are not accrued. Objective/Purpose: To show that treatment goals of dyslipidemic therapy should not be abandoned. Methods: The database of TexCAPS/AFCAPS is examined to determine the outcomes when lipid target goals are or are not met. Lipid data were drawn at baseline and at one year; outcomes data is for five years. The Cholesterol
Journal of Clinical Lipidology, Vol 8, No 3, June 2014 Retention Fraction (CRF, or [LDL-HDL]/LDL) has been show to be an excellent tool to guide treatment of dyslipidemia to maximize reduction in ATD events, especially when combined with systolic blood pressure (SBP). SBP and CRF can be combined into a risk factor graph with CRF on the ordinate and SBP on the abscissa. The ATD threshold line has line loci of (0.74,100) and (0.49,140). People with CRF-SBP plots in the area below this line, or whose CRF-SBP plots are brought below the threshold line, have a low incidence of ATD events. Results: 5405 patients had baseline CRF-SBP plots above the ATD threshold line. Of these patients, 2741 were treated with lovastatin and 2664 were treated with placebo; all received diet therapy. In the lovastatin cohort, 463 had their CRF-SBP plots brought below the threshold line. In the placebo cohort, only 71 achieved this goal. The overall incidence of ATD events in the baseline lovastatin group was 3.0%; those whose CRF-SBP plots were brought below the threshold line, however, had an ATD events rate of 1.7% (8 events in 463 patients), whereas those whose CRF-SBP plots remained above the threshold line had an ATD events rate of 3.2% (78 events in 2408 patients). (SBP data is missing in a number of patients, with the result that the above numbers in the various groups do not add to the same amounts.) Conclusion: Lovastatin therapy had no clinical benefit unless the target goal (CRF-SBP plot below the threshold line) was met. The AHA/ACC guidelines should be reconsidered as regards the abandonment of treatment goals.
131 Predicting the Population at Risk of Atherothrombotic Disease W. E. (William E.) Feeman Jr., MD, (Bowling Green, OH)
Lead Author’s Financial Disclosures: None Study Funding: None Background/Synopsis: The cardinal risk factors for atherothrombotic disease (ATD) are cigarette smoking, dyslipidemia, and hypertension. The Program on the Surgical Control of Hyperlipidemia (POSCH) has shown that coronary plaque can be stabilized/regressed by adequate control of dyslipidemia, independent of blood pressure control. Objective/Purpose: To show that the population at risk of ATD can be accurately predicted. Methods: The Bowling Green Study (BGS) has generated a lipid predictor, the Cholesterol Retention Fraction (CRF, or [LDL-HDL]/LDL). CRF sextiles can be stratified against LDL sextiles to determine which combinations of CRF and LDL best predict future ATD in the BGS and in TexCAPS/AFCAPS, and to characterize the lipid profiles of people who had previously sustained an acute myocardial infarction (POSCH). Results: Stratifying CRF and LDL sextiles in a 6x6 factorial, zones of ATD risk can be identified. The zone of
Study Funding: None Background/Synopsis: Changes in LDL-cholesterol versus changes in the Cholesterol Retention Fraction (CRF) as regards plaque progression versus non-progression in the Program on the Surgical Control of Hyperlipidemia (POSCH) were compared. No one whose CRF increased had plaque nonprogression and no one whose CRF decreased had plaque progression. If LDL remained the same or increased, plaque regression occurred in 28% of cases and if LDL decreased, plaque progression occurred in 11% of cases. Hence, the CRF is a superior predictor of plaque changes than LDL. Objective/Purpose: To show that the CRF is superior to LDL in predicting changes in plaque dynamics in response to therapy. Methods: The POSCH database was examined to determine plaque progression versus plaque non-progression in terms of changes in LDL or CRF. CRF is defined as (LDLHDL)/LDL. The POSCH study utilized a low cholesterol diet, with some patients receiving a partial ileal bypass as active treatment. Lipid profiles wee obtained at baseline and one year; angiograms, at one and three years. All patients had sustained an acute myocardial infarction prior to trial entry. Results: No one whose CRF increased had plaque nonprogression and no one whose CRF decreased had plaque progression. In patients whose LDL rose or did not change, plaque non-progression occurred in 37/134 (28%) of cases; in patients whose LDL fell, plaque progression occurred in 66/597 (11%) of cases. Conclusion: The CRF is superior to LDL in predicting plaque changes in response to therapy in POSCH. 130 Atherothrombotic Outcomes When Lipid Target Goals Are Not Met W. E. (William E.) Feeman Jr., MD, (Bowling Green, OH)
Lead Author’s Financial Disclosures: None Study Funding: None Background/Synopsis: Dyslipidemia is a leading cause of atherothrombotic disease (ATD) its treatment therefore should be targeted to achieving maximal reduction of ATD events. The recent American Heart Association/American Academy of Cardiology (AHA/ACC) guidelines have abandoned target lipid goals of therapy. The database of an outcomes study (TexCAPS/AFCAPS) will be examined and will show that when specified treatment goals are met, beneficial effects are maximized, but when they are not met, such benefits are not accrued. Objective/Purpose: To show that treatment goals of dyslipidemic therapy should not be abandoned. Methods: The database of TexCAPS/AFCAPS is examined to determine the outcomes when lipid target goals are or are not met. Lipid data were drawn at baseline and at one year; outcomes data is for five years. The Cholesterol
Journal of Clinical Lipidology, Vol 8, No 3, June 2014 Retention Fraction (CRF, or [LDL-HDL]/LDL) has been show to be an excellent tool to guide treatment of dyslipidemia to maximize reduction in ATD events, especially when combined with systolic blood pressure (SBP). SBP and CRF can be combined into a risk factor graph with CRF on the ordinate and SBP on the abscissa. The ATD threshold line has line loci of (0.74,100) and (0.49,140). People with CRF-SBP plots in the area below this line, or whose CRF-SBP plots are brought below the threshold line, have a low incidence of ATD events. Results: 5405 patients had baseline CRF-SBP plots above the ATD threshold line. Of these patients, 2741 were treated with lovastatin and 2664 were treated with placebo; all received diet therapy. In the lovastatin cohort, 463 had their CRF-SBP plots brought below the threshold line. In the placebo cohort, only 71 achieved this goal. The overall incidence of ATD events in the baseline lovastatin group was 3.0%; those whose CRF-SBP plots were brought below the threshold line, however, had an ATD events rate of 1.7% (8 events in 463 patients), whereas those whose CRF-SBP plots remained above the threshold line had an ATD events rate of 3.2% (78 events in 2408 patients). (SBP data is missing in a number of patients, with the result that the above numbers in the various groups do not add to the same amounts.) Conclusion: Lovastatin therapy had no clinical benefit unless the target goal (CRF-SBP plot below the threshold line) was met. The AHA/ACC guidelines should be reconsidered as regards the abandonment of treatment goals.
131 Predicting the Population at Risk of Atherothrombotic Disease W. E. (William E.) Feeman Jr., MD, (Bowling Green, OH)
Lead Author’s Financial Disclosures: None Study Funding: None Background/Synopsis: The cardinal risk factors for atherothrombotic disease (ATD) are cigarette smoking, dyslipidemia, and hypertension. The Program on the Surgical Control of Hyperlipidemia (POSCH) has shown that coronary plaque can be stabilized/regressed by adequate control of dyslipidemia, independent of blood pressure control. Objective/Purpose: To show that the population at risk of ATD can be accurately predicted. Methods: The Bowling Green Study (BGS) has generated a lipid predictor, the Cholesterol Retention Fraction (CRF, or [LDL-HDL]/LDL). CRF sextiles can be stratified against LDL sextiles to determine which combinations of CRF and LDL best predict future ATD in the BGS and in TexCAPS/AFCAPS, and to characterize the lipid profiles of people who had previously sustained an acute myocardial infarction (POSCH). Results: Stratifying CRF and LDL sextiles in a 6x6 factorial, zones of ATD risk can be identified. The zone of