期刊
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
卷 62, 期 20, 页码 1826-1833出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2013.07.051
关键词
HDL cholesterol; residual risk; stable ischemic heart disease
资金
- U.S. Department of Veterans Affairs Office of Research and Development
- Canadian Institutes of Health Research
- Merck
- Pfizer
- Bristol-Myers Squibb
- Fujisawa
- Kos Pharmaceuticals
- Datascope
- AstraZeneca
- Key Pharmaceutical
- sanofi-aventis
- First Horizon
- GE Healthcare
- U.S. Department of Veterans Affairs
- Gilead
- Genentech
- Amgen
- Eli Lilly Company
- American Heart Association
- American College of Cardiology Foundation
- United Healthcare
- Health Outcomes Science
Objectives This study sought to assess the independent effect of high-density lipoprotein-cholesterol (HDL-C) level on cardiovascular risk in patients with stable ischemic heart disease (SIHD) who were receiving optimal medical therapy (OMT). Background Although low HDL-C level is a powerful and independent predictor of cardiovascular risk, recent data suggest that this may not apply when low-density lipoprotein-cholesterol (LDL-C) is reduced to optimal levels using intensive statin therapy. Methods We performed a post-hoc analysis in 2,193 men and women with SIHD from the COURAGE trial. The primary outcome measure was the composite of death from any cause or nonfatal myocardial infarction (MI). The independent association between HDL-C levels measured after 6 months on OMT and the rate of cardiovascular events after 4 years was assessed. Similar analyses were performed separately in subjects with LDL-C levels below 70 mg/dl (1.8 mmol/l). Results In the overall population, the rate of death/MI was 33% lower in the highest HDL-C quartile as compared with the lowest quartile, with quartile of HDL-C being a significant, independent predictor of death/MI (p = 0.05), but with no interaction for LDL-C category (p = 0.40). Among subjects with LDL-C levels < 70 mg/dl, those in the highest quintile of HDL-C had a 65% relative risk reduction in death or MI as compared with the lowest quintile, with HDL-C quintile demonstrating a significant, inverse predictive effect (p = 0.02). Conclusions In this post-hoc analysis, patients with SIHD continued to experience incremental cardiovascular risk associated with low HDL-C levels despite OMT during long-term follow-up. This relationship persisted and appeared more prominent even when LDL-C was reduced to optimal levels with intensive dyslipidemic therapy. (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation; NCT00007657) (C) 2013 by the American College of Cardiology Foundation
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