Abstract 4360415: Small, Dense LDL-C and Conventional LDL-C Similarly Predict Cardiovascular Risk and Benefit of Alirocumab in Statin-Treated Patients With Recent Acute Coronary Syndrome
Bibliographic record
Abstract
Introduction: Small, dense low-density lipoprotein (sdLDL) particles are believed to be a highly atherogenic subfraction of LDL due to prolonged residence time in circulation, greater adherence to and penetration of vascular endothelium, and higher susceptibility to oxidation. Automated biochemical measurement of sdLDL cholesterol (sdLDL-C) has demonstrated good fidelity to gold standard gradient ultracentrifugation or NMR spectroscopy. We evaluated the relationship of sdLDL-C and conventional LDL-C to risk of major adverse cardiovascular events (MACE) and treatment benefit of alirocumab in patients with recent acute coronary syndrome (ACS) receiving high-intensity or maximum-tolerated statin treatment. Methods: The analysis included 11,837 participants in the ODYSSEY OUTCOMES trial (NCT01663402) with recent ACS and LDL-C ≥70 mg/dL despite optimized statin treatment. At baseline prior to randomized treatment with the PCSK9 monoclonal antibody alirocumab (N=5917) or placebo (N=5920), sdLDL-C was measured using the Denka (Nigata, Japan) method on a Roche cobas autoanalyzer and LDL-C was calculated with the Friedewald formula. In the placebo group, natural cubic splines depicted the relationships of sdLDL-C, LDL-C, and their ratio to the risk of MACE (CV death, non-fatal myocardial infarction or ischemic stroke, hospitalization for unstable angina, and ischemia-driven coronary revascularization) and treatment hazard ratio (HR: alirocumab/placebo) as a function of sdLDL-C and LDL-C. Results: In Figure Panel A, the risk of MACE in the placebo group increased with concentrations of baseline sdLDL-C and LDL-C, with nearly superimposable splines. In Panel B, the relationship of sdLDL-C/LDL-C to risk of MACE in the placebo group (adjusted for LDL-C) showed no evidence of greater risk with greater sdLDL-C fraction. Overall, alirocumab reduced the risk of MACE (HR 0.87, 95% CI 0.79, 0.95). Panel C shows that the treatment HR did not vary significantly across the range of either LDL-C or sdLDL-C. Conclusion: In patients with recent ACS and LDL-C ≥70 mg/dL on optimized statin treatment, sdLDL-C and conventional LDL-C similarly predict risk of MACE and benefit of treatment with alirocumab. Measurement of sdLDL-C does not appear to provide additional prognostic or predictive information.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".