Ray KK ， Cannon CP ， Cairns R ， Morrow DA ， Ridker PM ， Braunwald E .
TIMI Study Group， Cardiovascular Division and the Department of Medicine， Brigham and Women’s Hospital/Harvard Medical School， Boston， MA 02115， USA.
Abstract
OBJECTIVES: The purpose of this study was to compare the prognostic utility of apoB/AI， total cholesterol/HDL (TC/HDL) ratio， non-HDL cholesterol (non-HDL-C)， or hs-CRP as predictors of clinical risk among patients receiving statin therapy after acute coronary syndromes (ACS).
METHODS AND RESULTS: Patients with ACS were randomized in the PROVE IT-TIMI 22 trial to either pravastatin 40 mg or atorvastatin 80 mg. Cox regression models adjusting for confounders were used to assess the relationship between on-treatment lipids or hs-CRP and risk of death or acute coronary events. At 4 months a 1 SD increment in apoB/AI (HR 1.10， 95% CI 1.01 to 1.20)， TC/HDL (HR 1.12， 95% CI 1.01 to 1.24)， and non-HDL-C (HR 1.20， 95% CI 1.07 to 1.35) predicted events to a similar extent as LDL-C (HR 1.20， 95% CI 1.07 to 1.35) with neither apoB/AI， TC/HDL， nor non-HDL-C improving risk prediction models which included LDL-C. In contrast， the addition of hs-CRP significantly improved risk prediction models irrespective of the lipid parameters included， with a 29% to 30% increased risk observed per 1 SD increment in log CRP.
CONCLUSION: In the present study of ACS patients receiving statin therapy， on-treatment apoB/AI， TC/HDL， and non-HDL-C offered similar prognostic information to LDL-C. However， the addition of hs-CRP to lipid-based measurements significantly improved risk prediction. On treatment CRP measurement may therefore offer additive prognostic information to lipids in ACS patients.