Abstract 16414: Non-High-Density-Lipoprotein Cholesterol is an Important Residual Risk Factor in the Secondary Prevention for Patients With Established Atherosclerotic Cardiovascular Diseases
Introduction: Secondary prevention of cardiovascular (CV) events is important for patients with established atherosclerotic CV diseases (ASCVD). Non-high-density-lipoprotein cholesterol (N-HDL-C) has been increasingly signified as an important risk factor for ASCVD.
Purpose: To verify the role of N-HDL-C in the secondary prevention for patients with established ASCVD.
Materials and Methods: Taiwanese Secondary Prevention for Patients with AtheRosCLErotic Disease (T-SPARCLE) Registry is a prospective cohort conducted since 2010 enrolling patients with established ASCVD from 18 centers in Taiwan. In this study, N-HDL-C levels at enrollment was divided into four groups (< 100, 100-129, 130-159 and ≥ 160 mg/dl) to stratify the risk associated with composite primary end point of cardiovascular death, myocardial infarction, stroke, and cardiac arrest with cardiopulmonary resuscitation. Multivariate Cox proportional hazards model was employed to elucidate the role of N-HDL-C in predicting the primary outcome. Further, analysis was done in patients already under statin treatment to clarify the value of N-HDL-C in this era of statin therapy.
Results: A total of 4,099 patients (male 74.4%, age 65.6 ± 11.9 years old) were enrolled from Jan. 2010 to Aug. 2014. One hundred and nine primary outcomes were recorded during follow-up with a mean of 2 years. In multivariate Cox proportional hazards model, N-HDL-C ≥ 160 (HR 2.01, 95% CI 1.02 - 3.98, P < 0.05) and 130-159 mg/dl (HR 1.97, 95% CI 1.04 - 3.72, P < 0.05), together with smoking (HR 1.62, 95% CI 1.02 - 2.58, P < 0.05), diabetes mellitus (HR 1.63, 95% CI 1.10 - 2.41, P < 0.05), congestive heart failure (HR 2.21, 95% CI 1.41 - 3.46, P < 0.001) and estimated glomerular filtration rate (eGFR) < 30 ml/min (HR 3.25, 95% CI 1.78 - 5.95, P < 0.001), serve as independent risk factors for major CV events. For patients already under statin treatment (n=2,933), N-HDL-C ≥ 160 (HR 2.39, 95% CI 1.10 - 5.22, P < 0.05) is still associated with greater risk compared to N-HDL-C < 100 mg/dl.
Conclusion: N-HDL-C is an important residual risk factor in the secondary prevention for patients with established ASCVD. Aggressive control to lower N-HDL-C is mandated in this group of patients.
Author Disclosures: W. Chang: None. W. Yin: None. F. Lin: None. W. Tseng: None. Y. Wu: None. Y. Li: None. H. Yeh: None. J. Chen: None. C. Wu: None.
- © 2016 by American Heart Association, Inc.