Oxidized Phospholipids and CV Outcomes | Journal Scan

Mar 30, 2015
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Authors:
Byun YS, Lee JH, Arsenault BJ, et al., on behalf of the TNT Trial Investigators.
Citation:
Relationship of Oxidized Phospholipids on Apolipoprotein B-100 to Cardiovascular Outcomes in Patients Treated With Intensive Versus Moderate Atorvastatin Therapy: The TNT Trial. J Am Coll Cardiol 2015;65:1286-1295.
Summary By:
Daniel T. Eitzman, MD

Study Questions:

Do circulating levels of oxidized phospholipids on apolipoprotein B (OxPL-apoB) predict cardiovascular (CV) outcomes?

Methods:

OxPL-apoB levels were measured in 1,503 patients from the TNT (Treating to New Targets) trial at baseline (after an 8-week atorvastatin 10 mg run-in) and 1 year later. The association between baseline levels of OxPL-apoB and major adverse cardiac events (MACE), as well as the effect of statin therapy on OxPL-apoB levels and MACE, were studied.

Results:

Patients with events (n = 156) had higher levels of OxPL-apoB than those without events (p = 0.025). For the overall cohort, baseline levels of OxPL-apoB predicted subsequent MACE (hazard ratio [HR], 1.21; p = 0.018) per doubling and tertile 3 versus tertile 1 (HR, 1.69; p = 0.01) after adjustment for multiple factors and treatment assignment. This effect remained significant in the low-dose, but not high-dose atorvastatin group.

Conclusions:

The authors concluded that elevated OxPL-apoB levels predict MACE in patients with stable coronary heart disease, and that this risk is mitigated by atorvastatin 80 mg.

Perspective:

Statins are effective in reducing low-density lipoprotein (LDL) cholesterol and lowering CV risk. Biomarkers may help further guide medical therapy for patients at risk for CV disease (CVD), especially if the biomarker is causally related to CVD. Oxidized forms of LDL may be particularly important in activating inflammatory pathways relevant to coronary artery disease. This study adds to previous primary prevention studies by demonstrating that OxPL-apoB levels predict MACE in patients with established coronary artery disease. Surprisingly, OxPL-apoB levels increased following treatment with high-dose atorvastatin. The authors suggest that this may be due to efflux of OxPL from the vessel into the circulation. Additional studies will be useful to determine the clinical utility of OxPL measurements as well as their response to statin treatment.

Keywords: Apolipoproteins B, Biomarkers, Cholesterol, Coronary Artery Disease, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Lipoproteins, LDL, Dyslipidemias, Phospholipids, Primary Prevention, Heptanoic Acids, Pyrroles, Trinitrotoluene, Acute Coronary Syndrome


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