Low High-Density Lipoprotein Cholesterol Is Not a Risk Factor for Recurrent Vascular Events in Patients With Vascular Disease on Intensive Lipid-Lowering Medication
| Autor: | Anton P, van de Woestijne, Yolanda, van der Graaf, An-Ho, Liem, Maarten J M, Cramer, Jan, Westerink, Frank L J, Visseren |
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| Jazyk: | angličtina |
| Předmět: |
Male
medicine.medical_specialty Myocardial Ischemia statins Recurrence Risk Factors Interquartile range HDL cholesterol Internal medicine medicine Humans Prospective Studies Myocardial infarction Risk factor Prospective cohort study Stroke Aged Netherlands Proportional Hazards Models business.industry Vascular disease Proportional hazards model Anticholesteremic Agents Cholesterol HDL Hazard ratio Cholesterol LDL Middle Aged medicine.disease LDL cholesterol Physical therapy Female lipids (amino acids peptides and proteins) Hydroxymethylglutaryl-CoA Reductase Inhibitors Cardiology and Cardiovascular Medicine business secondary prevention |
| Zdroj: | Journal of the American College of Cardiology. (20):1834-1841 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/j.jacc.2013.04.101 |
| Popis: | Objectives This study sought to evaluate the vascular risk of low high-density lipoprotein-cholesterol (HDL-C) in relation to the use and intensity of lipid-lowering medication in patients with clinically manifest vascular diseases. Background Low levels of HDL-C are associated with an increased risk for vascular diseases and may contribute to residual vascular risk in patients already treated for other risk factors. However, post-hoc analyses from statin trials indicate that the vascular risk associated with low HDL-C may be low or even absent in patients using intensive statin therapy. Methods We performed a prospective cohort study of 6,111 patients with manifest vascular disease. Cox proportional hazards models were used to evaluate the risk of HDL-C on vascular events in patients using no, usual dose, or intensive lipid-lowering therapy. Results New vascular events (myocardial infarction, stroke, or vascular death) occurred in 874 subjects during a median follow-up of 5.4 years (interquartile range: 2.9 to 8.6 years). In patients not using lipid-lowering medication at baseline (n = 2,153), a 0.1 mmol/l increase in HDL-C was associated with a 5% reduced risk for all vascular events (hazard ratio [HR]: 0.95; 95% confidence interval [CI]: 0.92 to 0.99). In patients on usual dose lipid-lowering medication (n = 1,910) there was a 6% reduced risk (HR: 0.94; 95% CI: 0.90 to 0.98). However, in patients using intensive lipid-lowering treatment (n = 2,046), HDL-C was not associated with recurrent vascular events (HR: 1.02; 95% CI: 0.98 to 1.07) irrespective of low-density lipoprotein cholesterol level. Conclusions In patients with clinically manifest vascular disease using no or usual dose lipid-lowering medication, low plasma HDL-C levels are related to increased vascular risk, whereas in patients using intensive lipid-lowering medication, HDL-C levels are not related to vascular risk. |
| Databáze: | OpenAIRE |
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