Targets of statin therapy: LDL cholesterol, non-HDL cholesterol, and apoliproprotein B in Type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS)

Valentine Charlton-Menys, D. John Betteridge, Helen Colhoun, John Fuller, Michael France, Graham A. Hitman, Shona J. Livingstone, H. Andrew W. Neil, Connie B. Newman, Michael Szarek, David A. DeMicco, Paul N. Durrington

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    BACKGROUND: LDL can vary considerably in its cholesterol content; thus, lowering LDL cholesterol (LDLC) as a goal of statin treatment implies the existence of considerable variation in the extent to which statin treatment removes circulating LDL particles. This consideration is particularly applicable in diabetes mellitus, in which LDL is frequently depleted of cholesterol.

    METHODS: Type 2 diabetes patients randomly allocated to 10 mg/day atorvastatin (n = 1154) or to placebo (n = 1196) for 1 year were studied to compare spontaneous and statin-induced apolipoprotein B (apo B) concentrations (a measure of LDL particle concentration) at LDLC and non-HDL cholesterol (non-HDLC) concentrations proposed as statin targets in type 2 diabetes.

    RESULTS: Patients treated with atorvastatin produced lower serum apo B concentrations at any given LDLC concentration than patients on placebo. All LDLC concentration of 1.8 mmol/L (70 mg/dL) during atorvastatin treatment was equivalent to a non-HDLC concentration of 2.59 mmol/L (100 mg/dL) or an apo B concentration of 0.8 g/L. At the more conservative LDLC targets of 2.59 mmol/L (100 mg/dL) and 3.37 mmol/L (130 mg/dL) for non-HDLC, however, the apo B concentration exceeded the 0.9-g/L value anticipated in the recent Consensus Statement from the American Diabetes Association and the American College of Cardiology.

    CONCLUSIONS: The apo B concentration provides a more consistent goal for statin treatment than the LDLC or non-HDLC concentration. (C) 2008 American Association for Clinical Chemistry

    Original languageEnglish
    Pages (from-to)473-480
    Number of pages8
    JournalClinical Chemistry
    Issue number3
    Publication statusPublished - Mar 2009


    • Low density lipoprotein
    • Coronary heart disease
    • 14 randomized trials
    • Cardiovascular disease
    • Apolipoprotein-B
    • APO-B
    • Combined hyperlipidemia
    • Primary prevention
    • Clinical practice
    • Ester transfer

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