Determinants of residual risk in secondary prevention patients treated with high- versus low-dose statin therapy: the Treating to New Targets (TNT) study
| Autor: | Samia Mora, David A. DeMicco, S. Matthijs Boekholdt, Andrei Breazna, John J.P. Kastelein, David D. Waters, Nanette K. Wenger, Prakash Deedwania, Benoit J. Arsenault |
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| Přispěvatelé: | ACS - Amsterdam Cardiovascular Sciences, Cardiology, Vascular Medicine |
| Jazyk: | angličtina |
| Rok vydání: | 2012 |
| Předmět: |
Oncology
Adult Male Risk medicine.medical_specialty Atorvastatin Myocardial Infarction Article law.invention Body Mass Index Sex Factors Randomized controlled trial law Physiology (medical) Internal medicine medicine Humans Pyrroles Myocardial infarction Stroke Aged Secondary prevention business.industry Anticholesteremic Agents Age Factors Cholesterol LDL Middle Aged medicine.disease Cardiopulmonary Resuscitation Heart Arrest Residual risk Death Sudden Cardiac Heptanoic Acids Hypertension Physical therapy Female Hydroxymethylglutaryl-CoA Reductase Inhibitors Cardiology and Cardiovascular Medicine Risk assessment business Body mass index medicine.drug |
| Zdroj: | Circulation, 125(16), 1979-1987. Lippincott Williams and Wilkins |
| ISSN: | 0009-7322 |
| Popis: | Background— Cardiovascular events occur among statin-treated patients, albeit at lower rates. Risk factors for this “residual risk” have not been studied comprehensively. We aimed to identify determinants of this risk above and beyond lipid-related risk factors. Methods and Results— A total of 9251 coronary patients with low-density lipoprotein cholesterol 2 ), male sex (aHR, 1.33; 95% CI, 1.07–1.65), hypertension (aHR, 1.38; 95% CI, 1.17–1.63), diabetes mellitus (aHR, 1.33; 95% CI, 1.11–1.60), baseline apolipoprotein B (aHR, 1.19; 95% CI, 1.11–1.28 per 19 mg/dL), and blood urea nitrogen (aHR, 1.10; 95% CI, 1.03–1.17 per 4.9 mg/dL), in addition to current smoking, prior cardiovascular disease, and calcium channel blocker use. Determinants of decreased risk were high-dose statin (aHR, 0.82; 95% CI, 0.70–0.94), aspirin use (aHR, 0.67; 95% CI, 0.56–0.81), and baseline apolipoprotein A-I (aHR, 0.91; 95% CI, 0.84–0.99 per 25 mg/dL). On-treatment 1-year lipids or apolipoproteins were not additionally associated with risk in multivariable models. Known baseline variables performed moderately well in discriminating future cases from noncases (Harrell c index=0.679). Conclusions— Determinants of residual risk in statin-treated secondary prevention patients included lipid-related and nonlipid factors such as baseline apolipoproteins, increased body mass index, smoking, hypertension, and diabetes mellitus. A multifaceted prevention approach should be underscored to address this risk. Clinical Trial Registration— URL: http://clinicaltrials.gov . Unique identifier: NCT00327691. |
| Databáze: | OpenAIRE |
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