Targets for LDL-lowering therapy

PURPOSE OF REVIEW: To compare non-HDL-cholesterol (non-HDL-C) and apolipoprotein B (apoB) as targets for LDL-lowering therapy. The conventional approach is restricted to a comparison of in-trial data. Although essential, this overlooks the issue as to which marker better identifies residual risk after any particular treatment regimen. RECENT FINDINGS: Data from a series of recent studies, including Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin, Measuring Effective Reductions in Cholesterol Using Rosuvastatin Therapy II, Treating to New Targets-Incremental Decrease in End Points Through Aggressive Lipid Lowering and Collaborative Atorvastatin Diabetes Study, demonstrating that apoB better identifies residual risk than non-HDL-C will be reviewed. SUMMARY: Comparing markers such as non-HDL-C and apoB for the accuracy with which they identify risk during a trial is essential but not sufficient. It is also necessary to compare markers for how well they identify residual risk, and, in this regard, apoB clearly outperforms non-HDL-C.