Circulation, Vol 86, 1165-1170, Copyright © 1992 by American Heart Association
M Miller, A Seidler, PO Kwiterovich and TA Pearson
BACKGROUND. Patients with coronary artery disease (CAD) are at considerable
risk for subsequent cardiovascular events. Although hyperlipidemia
accentuates the risk, predictors of subsequent events with CAD and
desirable total cholesterol (TC) (less than 5.2 mmol/l) have not been
assessed. METHODS AND RESULTS. A survival analysis was performed in a
subset of 740 consecutive patients who underwent diagnostic coronary
arteriography between 1977 and 1978. Eight-three men and 24 women with
angiographically documented CAD and desirable TC were followed for
subsequent cardiovascular events, including myocardial infarction and
cardiovascular death. Over a 13-year period, 75% of CAD subjects with
reduced high density lipoprotein cholesterol (HDL-C) (less than 0.9 mmol/l)
developed a subsequent cardiovascular event compared with 45% of those with
HDL-C greater than or equal to 0.9 mmol/l (p = 0.002). A Kaplan-Meier
analysis revealed significantly greater survival from cardiovascular end
points in patients with baseline levels of HDL-C greater than or equal to
0.9 mmol/l (p = 0.005). After 11 variables were tested, an age-adjusted Cox
proportional-hazards model identified two pairs of independent predictors
of subsequent cardiovascular events: they were a left ventricular ejection
fraction (LVEF) less than 35% (relative risk [RR], 6.5; 95% confidence
interval [CI], 2.8, 15.3; p less than 0.001) and reduced HDL-C (RR, 2.0;
95% CI, 1.2, 3.3; p = 0.01) in the first model and LVEF less than 35% (RR,
6.5; 95% CI, 2.7, 15.6; p less than 0.001) and TC:HDL ratio greater than or
equal to 5.5 (RR, 1.9; 95% CI, 1.1, 3.1; p = 0.02) in the second model.
CONCLUSIONS. Low HDL-C (or high TC:HDL-C) is strongly predictive of
subsequent cardiovascular events in subjects with CAD, despite desirable
TC. As such, identification of this potentially modifiable risk factor
should be actively pursued in this high-risk subgroup.
ARTICLES
Long-term predictors of subsequent cardiovascular events with coronary artery disease and 'desirable' levels of plasma total cholesterol
Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD.
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