Plasma lipoproteins and apolipoproteins as predictors of cardiovascular risk and treatment benefit in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER)
Abstract
Background— Statins are important in vascular disease prevention in the elderly. However, the best method of selecting older patients for treatment is uncertain. We assessed the role of plasma lipoproteins as predictors of risk and of treatment benefit in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). Method and Results— The association of LDLc and HDLc with risk was examined in the 5804 70- to 82-year-old subjects of PROSPER. Baseline LDLc showed no relation to risk of the primary end point in the placebo group ( P =0.27), nor did on-treatment LDLc in the pravastatin group ( P =0.12). HDLc was inversely associated with risk in subjects on placebo ( P =0.0019) but not in those on pravastatin ( P =0.24). Risk reduction on pravastatin treatment was unrelated to baseline LDLc ( P =0.38) but exhibited a significant interaction with HDLc ( P =0.012). Subjects in the lowest 2 quintiles of HDLc (<1.15 mmol/L) had a risk reduction of 33% (hazard ratio, 0.67; 95% confidence limits, 0.55, 0.81; P <0.0001), whereas those with higher HDLc showed no benefit (RR, 1.06; 95% confidence limits, 0.88, 1.27; P =0.53). During follow-up, there was no relation between achieved level of LDLc or HDLc and risk. However, the change in the LDLc/HDLc ratio on statin treatment appeared to account for the effects of therapy. Conclusions— In people >70 years old, HDLc appears to be a key predictor of risk and of treatment benefit. Findings in PROSPER suggest that statin therapy could usefully be targeted to those with HDLc <1.15 mmol/L or an LDLc/HDLc ratio >3.3.
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A possible explanation for the independence of plasma lipids in the 546 elderly study may be that it only included individuals at age 85 at baseline, an age range shown not to reproduce the strong risk association between plasma lipids and cardiovascular disease.
“A possible explanation for the independence of plasma lipids in the study of 546 elderly individuals may be that the study only included individuals at the age of 85 years at baseline, an age-range shown not to reproduce the well-known strong risk association between plasma lipids and”
From Plasma levels of apolipoprotein E, APOE genotype and risk of dementia and ischemic heart disease: A review (2016) · cites this paper as [123]
In old age, only levels of HDL cholesterol, but not total cholesterol, LDL cholesterol, and triglycerides, affect cardiovascular disease risk.
“In contrast, in old age, only levels of HDL cholesterol, but not of total cholesterol, LDL cholesterol, and triglycerides, affect cardiovascular disease risk [ 12, 32, 38, 39].”
From ApoE Plasma Levels and Risk of Cardiovascular Mortality in Old Age (2006) · cites this paper as [39]
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- Authors
- Packard, C. J., Ford, I., Robertson, M., Shepherd, J., Blauw, G. J., Murphy, M. B., Bollen, E. L. E. M., Buckley, B. M., Cobbe, S. M., Gaw, A., Hyland, M., Jukema, J. W., Kamper, A. M., Macfarlane, P. W., Perry, I. J., Stott, D. J., Sweeney, B. J., Twomey, C., & Westendorp, R. G. J.
- Affiliations
- Leiden University Medical Center (NL)
- ORCID
- Venue
- Circulation
- Published
- 2005-11-15
- Volume
- 112
- Issue
- 20
- Pages
- 3058-3065
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2155045850
- Cited by
- 121
- References
- 3
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 3 · 2023: 3 · 2022: 6 · 2021: 1 · 2020: 7 · 2019: 3 · 2018: 3 · 2017: 5 · 2016: 4 · 2015: 4 · 2014: 8 · 2013: 3 · 2012: 10
- FWCI
- 9.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- pravastatin, statin therapy, HDL cholesterol, LDL cholesterol, LDL/HDL ratio, cardiovascular risk prediction, treatment benefit, elderly patients, PROSPER trial, apolipoproteins
- MeSH terms
- Aged, Aged, 80 and over, Apolipoproteins, Cardiovascular Diseases, Humans, Lipoproteins, Cholesterol, HDL, Cholesterol, LDL, Biomarkers, Incidence, Pravastatin, Risk Assessment, Hydroxymethylglutaryl-CoA Reductase Inhibitors
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