Abstract 12796: Synergic Impact of C-reactive Protein and High-density Lipoprotein Cholesterol on Long-term Clinical Outcomes in Patients With Coronary Artery Disease Treated With Statin
Background and Objective Clinical trials have shown that statins significantly reduce cardiovascular events in patients with coronary artery disease (CAD). However, residual cardiovascular risk persists despite intensive LDL-C reduction with statin. High-density lipoprotein cholesterol (HDL-C) is inversely associated with CAD that is independent of LDL-C level. High-sensitive C-reactive protein (hs-CRP) has been also established marker of CAD. Inflammation can impair the protective function of HDL-C, however the impact of inflammation on the association of HDL-C with long-term outcomes in CAD patients with statin therapy still remains uncertain. We evaluated the combined effect of HDL-C and hsCRP on long-term clinical outcomes in CAD patients treated with statins after coronary intervention.
Methods We prospectively enrolled 2165 consecutive CAD patients who underwent first percutaneous coronary intervention (PCI) between 1997 and 2006 at our institution. We identified 925 patients (43%) who had treated with statin during PCI. Patients were stratified to four groups according to HDL-C levels (40 mg/dL for men or 50 mg/dL for women) and hsCRP(0.2 mg/dL). Major adverse cardiac events (MACE) that included all-cause death, non-fatal myocardial infarction were evaluated among four groups.
Results The median follow-up period was 1920 days. The rate of MACE was significantly different among the groups (log-rank p < 0.0001) in patients. Multivariate Cox regression analysis showed patients with low HDL-C/high hs-CRP is significantly associated with clinical outcomes compared with high HDL-C/low hs-CRP (adjusted HR for MACE 2.47, 95%CI 1.50-4.06, p < 0.0001).
Conclusion Low HDL-C with elevated levels of hs-CRP is a residual risk factor that is significantly associated with long-term clinical outcomes among CAD patients with statin therapy after PCI.
- © 2012 by American Heart Association, Inc.