Effect of Alirocumab on Lipoprotein(a) and Cardiovascular Risk After Acute Coronary Syndrome
Vera A. Bittner, Michael Szarek, Philip E. Aylward, Deepak L. Bhatt, Rafael Diaz, Jay M. Edelberg, Zlatko Fras, Shaun G. Goodman, Sigrun Halvorsen, Corinne Hanotin, Robert A. Harrington, J. Wouter Jukema, Virginie Loizeau, Patrick M. Moriarty, Angèle Moryusef, Robert Pordy, Matthew T. Roe, Peter Sinnaeve, Sotirios Tsimikas, Robert Vogel, Harvey D. White, Doron Zahger, Andreas M. Zeiher, Ph. Gabriel Steg, Gregory G. Schwartz and for the ODYSSEY OUTCOMES Committees and Investigators
Relative Contributions of Changes in Concentrations of Corrected Low-Density Lipoprotein Cholesterol, Corrected Non-High-Density Lipoprotein Cholesterol, and Lipoprotein(a) to the Absolute Reduction in Major Adverse Cardiovascular Events in the Alirocumab Group
Based on models with adjustments for baseline levels shown in Table 1 (Models 3A and 3B), A shows the absolute contributions of reductions in lipoprotein(a) [Lp(a)] and low-density lipoprotein cholesterol corrected for the cholesterol in Lp(a) (LDL-Ccorr) to the predicted 4-year absolute reduction in major adverse cardiovascular events (MACE) at the 25th, 50th, and 75th percentile of baseline Lp(a) concentration (Model 3A), while B shows the corresponding data for reductions in non-high-density lipoprotein cholesterol corrected for the cholesterol in Lp(a) (non-HDL-Ccorr) (Model 3B). The absolute contribution of Lp(a) reduction to reduced risk of MACE was minimal when baseline Lp(a) concentration was low but was substantial when baseline Lp(a) concentration was high. The expected baseline levels at the 25th, 50th, and 75th percentiles of baseline Lp(a) are 87.3 mg/dl, 84.3 mg/dl, and 76.4 mg/dl, respectively for LDL-Ccorr and 118.2 mg/dl, 114.7 mg/dl, and 105.4 mg/dl, respectively, for non-HDL-Ccorr. The expected reductions at the 25th, 50th, and 75th percentiles of baseline Lp(a) are 1.6 mg/dl, 4.8 mg/dl, and 13.4 mg/dl, respectively, for Lp(a), 51.1 mg/dl, 50.5 mg/dl, and 48.9 mg/dl, respectively, for LDL-Ccorr, and 57.1 mg/dl, 56.2 mg/dl, and 53.9 mg/dl, respectively, for non-HDL-Ccorr.