Lower levels of high-density lipoprotein cholesterol are associated with increased cardiovascular events in patients with acute coronary syndrome,Atherosclerosis

当前位置： X-MOL 学术 › Atherosclerosis › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Lower levels of high-density lipoprotein cholesterol are associated with increased cardiovascular events in patients with acute coronary syndrome
Atherosclerosis ( IF 4.9 ) Pub Date : 2020-06-01 , DOI: 10.1016/j.atherosclerosis.2020.05.005
Mayui Nakazawa ₁ , Hiroyuki Arashi ₁ , Junichi Yamaguchi ₁ , Hiroshi Ogawa ₁ , Nobuhisa Hagiwara ₁

Affiliation

BACKGROUND AND AIMS This study aimed to elucidate whether high-density lipoprotein cholesterol (HDL-C) at 3-month follow-up for patients receiving contemporary lipid-lowering therapy after acute coronary syndrome (ACS) could predict cardiac events. METHODS The HIJ-PROPER study was a multicenter, prospective, randomized trial comparing intensive lipid-lowering therapy (pitavastatin + ezetimibe) and conventional lipid-lowering therapy (pitavastatin monotherapy) after ACS. The entire cohort was divided into three groups according to tertiles of HDL-C levels at 3-month follow-up (Group 1, HDL-C ≤43 mg/dL; Group 2, HDL-C >43, <53.6 mg/dL; Group 3; HDL-C ≥53.6 mg/dL). Baseline characteristics and incidence of the primary endpoint (a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, unstable angina pectoris, or ischemia-driven revascularization) were compared among the three groups. RESULTS The primary endpoint event occurred in 34.8%, 30.1%, and 24.6% of patients in Groups 1, 2, and 3, respectively, and its incidence was significantly higher in Group 1 than in Group 3 (hazard ratio [HR], 1.5; 95% confidence interval [CI], 1.19-1.9; p = 0.001). Irrespective of the treatment regimen, Group 1 had significantly higher rates of the primary endpoint than Group 3 (pitavastatin + ezetimibe therapy: HR, 1.6; 95% CI, 1.12-2.22; p = 0.01 and pitavastatin monotherapy: HR, 1.4; 95% CI, 1.05-1.98; p = 0.02). These trends remained even after adjustment for baseline characteristics and lipid profiles. Multivariate analysis revealed that lower body mass index, prevalence of diabetes mellitus, higher levels of high-sensitivity C reactive protein at baseline, and lower levels of HDL-C at 3-month follow-up were independent predictors of the incidence of primary endpoint. CONCLUSIONS Lower levels of HDL-C at 3-month follow-up are independently associated with higher incidence of cardiovascular events in ACS patients receiving contemporary lipid-lowering therapy.

中文翻译：

较低水平的高密度脂蛋白胆固醇与急性冠脉综合征患者心血管事件增加有关

背景和目的本研究旨在阐明急性冠脉综合征 (ACS) 后接受现代降脂治疗的患者在 3 个月随访时的高密度脂蛋白胆固醇 (HDL-C) 是否可以预测心脏事件。方法 HIJ-PROPER 研究是一项多中心、前瞻性、随机试验，比较 ACS 后强化降脂治疗（匹伐他汀 + 依折麦布）和常规降脂治疗（匹伐他汀单药治疗）。根据 3 个月随访时 HDL-C 水平的三分位数将整个队列分为三组（第 1 组，HDL-C ≤43 mg/dL；第 2 组，HDL-C >43，<53.6 mg/dL ；第 3 组；HDL-C ≥53.6 mg/dL）。主要终点的基线特征和发生率（全因死亡、非致死性心肌梗死、非致死性中风、不稳定心绞痛、或缺血驱动的血运重建）在三组之间进行比较。结果在第 1、2 和 3 组中，主要终点事件发生率分别为 34.8%、30.1% 和 24.6%，且第 1 组的发生率显着高于第 3 组（风险比 [HR]，1.5 ；95% 置信区间 [CI]，1.19-1.9；p = 0.001)。无论采用何种治疗方案，第 1 组的主要终点发生率均显着高于第 3 组（匹伐他汀 + 依折麦布治疗：HR，1.6；95% CI，1.12-2.22；p = 0.01，匹伐他汀单药治疗：HR，1.4；95% CI，1.05-1.98；p = 0.02）。即使在调整了基线特征和脂质特征后，这些趋势仍然存在。多变量分析显示，较低的体重指数、糖尿病患病率、基线高敏 C 反应蛋白水平较高、3 个月随访时 HDL-C 水平较低是主要终点发生率的独立预测因子。结论在接受现代降脂治疗的 ACS 患者中，3 个月随访时较低的 HDL-C 水平与较高的心血管事件发生率独立相关。

更新日期：2020-06-01

点击分享查看原文

点击收藏

公开下载

阅读更多本刊最新论文本刊介绍/投稿指南11