Conclusions Study -level data from this systemic review establish that different lipid lowering agents can lead to discordance between LDL-P and LDL-C , therefore , basing LDL-lowering therapy only on the achievement of cholesterol goals may result in a treatment gap .
Therefore , the use of LDL-P for monitoring lipid-lowering therapy , particularly for statins , can provide a more accurate assessment of residual cardiovascular risk
Purpose This systematic review was performed to summarize published experience using low density lipoprotein particle number ( LDL-P ) to monitor the efficacy of  lipid-lowering pharmacotherapies .
Atheroprotective lipoprotein effects of a niacin-simvastatin combination compared to low- and high-dose simvastatin monotherapy.
BACKGROUND Niacin has multiple lipoprotein effects that may provide cardiovascular benefit when added to statin monotherapy . METHODS In this r and omized , placebo-controlled trial ( n = 75 ) of magnetic resonance imaging of carotid atherosclerosis , we performed a secondary comparison of combination niacin-statin ( simvastatin 20 mg/Niacin-ER 2 G [ S20/N ] ) to monotherapy with moderate ( 20 mg [ S20 ] ) and high-dose ( 80 mg [ S80 ] ) simvastatin on lipids , apolipoproteins ( apo ) , low density lipoprotein ( LDL ) and high density lipoprotein ( HDL ) particle subclasses , and inflammatory markers . RESULTS At baseline , average age was 71 , 72 % were male , 62.5 % used statins , and average LDL-cholesterol was 111 mg/dL. At 12 months , S20/N , compared to S80 , significantly reduced apoB ( -36.6 % vs -11.9 % ; P = .05 ) and lipoprotein(a ) ( -18 % vs + 3.5 % ; P = .001 ) and had at least an equivalent effect on LDL-cholesterol ( -39.3 % vs -24.3 % ; P = .24 ) . The combination reduced the proportion of subjects with atherogenic LDL pattern-B ( 50 % to 11.5 % ) compared to S80 ( 56 % to 56 % ) ( P = .01 ) . Despite increases in plasma free fatty acids ( + 62.4 % ; F = 5.65 , P = .005 vs S20 and S80 ) , plasma triglycerides ( -29.4 % ; F = 6.88 , P = .002 vs S20 and S80 ) , and very-low-density lipoprotein ( -44.2 % ; F = 7.94 , P < .001 vs S20 and S80 ) , levels were reduced by S20/N. S20/N increased HDL-cholesterol levels ( + 18.1 % ) as compared to S20 ( 0 % ) and S80 ( + 5.9 % ) ( P < .001 vs both statin arms ) , largely due to an increase in HDL particle size ( + 4.6 % ; P = .01 vs both statin arms ) . CONCLUSIONS We demonstrate that full-dose niacin/moderate-dose simvastatin combination has sustained benefits on atherogenic apoB lipoproteins , at least comparable to high-dose simvastatin , while also raising HDL-cholesterol . Results of large clinical trials will inform whether niacin-statin combinations reduce cardiovascular disease events
Conclusions Study -level data from this systemic review establish that different lipid lowering agents can lead to discordance between LDL-P and LDL-C , therefore , basing LDL-lowering therapy only on the achievement of cholesterol goals may result in a treatment gap .
Therefore , the use of LDL-P for monitoring lipid-lowering therapy , particularly for statins , can provide a more accurate assessment of residual cardiovascular risk
Purpose This systematic review was performed to summarize published experience using low density lipoprotein particle number ( LDL-P ) to monitor the efficacy of  lipid-lowering pharmacotherapies .