Journal
ATHEROSCLEROSIS
Volume 208, Issue 2, Pages 484-489Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.atherosclerosis.2009.08.026
Keywords
HDL cholesterol; Triglycerides; Diabetes; Coronary artery disease; Prognosis
Funding
- Innovationsstiftung of the Liechtenstein Global Trust (LGT) Bank (Bendern, Liechtenstein)
- Peter Goop Stiftung (Vaduz, Liechtenstein)
- Fachhochschule Dornbirn (Dornbirn, Austria)
- Institute for Clinical Chemistry at the Academic Teaching Hospital Feldkirch (Feldkirch, Austria)
- Vorarlberger Industriellenvereinigung (Bregenz, Austria)
- Vorarlberger Aerztekammer (Dornbirn, Austria)
- Vorarlberger Landesregierung
- Landessanitatsdirektor (Bregenz, Austria)
- Vorarlberger Landeskrankenhaus-Betriebsgesellschaft
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Objective: We aimed at identifying which lipid factors drive vascular risk in statin-treated patients with coronary artery disease (CAD). Methods: We recorded vascular events over 5.6 years in 491 consecutive statin-treated patients with angiographically proven stable CAD, covering 2750 patient-years. Results: In the total population, low high-density lipoprotein (HDL) cholesterol (standardized adjusted HR 0.73 [0.60-0.89]; p = 0.001), low apolipoprotein A1 (0.77 [0.65-0.92]; p = 0.003), a small low-density lipoprotein (LDL) particle diameter (0.76 [0.64-0.91]; p = 0.002), and high triglycerides (1.20 [1.05-1.38]; p = 0.007) predicted vascular events, but not total cholesterol, LDL cholesterol, or apolipoprotein B. Factor analysis in the lipid profiles of our patients revealed an HDL-related factor and an LDL-related factor. Concordant with the results for individual lipid parameters, the HDL-related factor (0.69 [0.58-0.83]; p < 0.001) but not the LDL-related factor (p = 0.455) predicted vascular events. Patients with type 2 diabetes (T2DM; n = 116) were at a higher vascular risk than non-diabetic subjects (38.6% vs. 24.1%; p < 0.001), and like in the total population the HDL-related factor (0.59 [0.44-0.77]; p < 0.001) but not the LDL-related factor (p = 0.591) predicted vascular risk in diabetic patients. Conclusions: The pattern of low HDL cholesterol, low apolipoprotein A1, small LDL particles, and high triglycerides drives vascular risk in statin-treated coronary patients, particularly in those with T2DM. (C) 2009 Elsevier Ireland Ltd. All rights reserved.
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