TY - JOUR
T1 - Non-HDL cholesterol and residual cardiovascular risk in statin-treated patients with and without diabetes
T2 - The Western Denmark Heart Registry
AU - Hansen, Malene Kærslund
AU - Mortensen, Martin Bødtker
AU - Olesen, Kevin Kris Warnakula
AU - Thrane, Pernille Gro
AU - Thomsen, Reimar Wernich
AU - Maeng, Michael
PY - 2024/8
Y1 - 2024/8
N2 - Aims Assessment of residual cardiovascular risk in statin-treated patients with atherosclerotic cardiovascular disease (ASCVD) is pivotal for optimizing secondary preventive therapies. This study investigates if non–high-density lipoprotein cholesterol (non-HDL-C) is associated with residual ASCVD risk in statin-treated ischaemic heart disease (IHD) patients with and without diabetes. Methods Using the Western Denmark Heart Registry, we identified statin-treated patients with IHD examined by coronary angiography and results (CAG) from 2011 to 2020. Non-HDL-C was assessed within 1 year after CAG. Outcomes were ASCVD (myocardial infarction, ischaemic stroke, and cardiovascular death) and all-cause death. Cox regression analyses obtained hazard ratios (HRs) adjusted for age, sex, smoking, and hypertension. A total of 42 057 patients were included: 8196 patients with diabetes and 33 861 without diabetes. During the median 4.6 years of follow-up, event rates per 1000 person-years of ASCVD were 28.8 (27.1–30.5) and 17.2 (16.5–17.8) among patients with and without diabetes. In patients with diabetes, the adjusted HRs of ASCVD as compared with non-HDL-C < 25th percentile were 1.0 (0.9–1.2), 1.3 (1.1–1.6), and 1.6 (1.2–2.1) for patients in the 25th–74th, 75th–94th, and ≥95th percentiles. In patients without diabetes, the corresponding adjusted HRs were 1.1 (0.9–1.1), 1.2 (1.1–1.4), and 1.7 (1.4–2.0). Results were consistent across sex, age, clinical presentation, and low-density lipoprotein cholesterol strata. Conclusion In statin-treated IHD patients with and without diabetes, non-HDL-C, especially above the 75th percentile, is associated with residual cardiovascular risk. These results have implications for secondary prevention, targeting patients who may benefit most from intensified preventive therapy. Lay summary Relevant to individuals, both with and without diabetes, who receive cholesterol-lowering therapy due to ischaemic heart disease, having a high level of non-HDL cholesterol is associated with risk of heart attack, stroke, and death. • In individuals with diabetes, having a high compared to a low non-HDL cholesterol level was associated with a 30–60% increased risk of heart attack, stroke, and death. For individuals without diabetes, the high non-HDL cholesterol level was linked to an increased risk by up to 70%. • In clinical practice, calculation of non-HDL cholesterol, from the standard lipid profile with no inconvenience to the patient, offers a possibility to identify patients who face a high risk of heart attack, stroke, and death. Patients with high levels of non-HDL cholesterol may benefit from optimized preventive therapy.
AB - Aims Assessment of residual cardiovascular risk in statin-treated patients with atherosclerotic cardiovascular disease (ASCVD) is pivotal for optimizing secondary preventive therapies. This study investigates if non–high-density lipoprotein cholesterol (non-HDL-C) is associated with residual ASCVD risk in statin-treated ischaemic heart disease (IHD) patients with and without diabetes. Methods Using the Western Denmark Heart Registry, we identified statin-treated patients with IHD examined by coronary angiography and results (CAG) from 2011 to 2020. Non-HDL-C was assessed within 1 year after CAG. Outcomes were ASCVD (myocardial infarction, ischaemic stroke, and cardiovascular death) and all-cause death. Cox regression analyses obtained hazard ratios (HRs) adjusted for age, sex, smoking, and hypertension. A total of 42 057 patients were included: 8196 patients with diabetes and 33 861 without diabetes. During the median 4.6 years of follow-up, event rates per 1000 person-years of ASCVD were 28.8 (27.1–30.5) and 17.2 (16.5–17.8) among patients with and without diabetes. In patients with diabetes, the adjusted HRs of ASCVD as compared with non-HDL-C < 25th percentile were 1.0 (0.9–1.2), 1.3 (1.1–1.6), and 1.6 (1.2–2.1) for patients in the 25th–74th, 75th–94th, and ≥95th percentiles. In patients without diabetes, the corresponding adjusted HRs were 1.1 (0.9–1.1), 1.2 (1.1–1.4), and 1.7 (1.4–2.0). Results were consistent across sex, age, clinical presentation, and low-density lipoprotein cholesterol strata. Conclusion In statin-treated IHD patients with and without diabetes, non-HDL-C, especially above the 75th percentile, is associated with residual cardiovascular risk. These results have implications for secondary prevention, targeting patients who may benefit most from intensified preventive therapy. Lay summary Relevant to individuals, both with and without diabetes, who receive cholesterol-lowering therapy due to ischaemic heart disease, having a high level of non-HDL cholesterol is associated with risk of heart attack, stroke, and death. • In individuals with diabetes, having a high compared to a low non-HDL cholesterol level was associated with a 30–60% increased risk of heart attack, stroke, and death. For individuals without diabetes, the high non-HDL cholesterol level was linked to an increased risk by up to 70%. • In clinical practice, calculation of non-HDL cholesterol, from the standard lipid profile with no inconvenience to the patient, offers a possibility to identify patients who face a high risk of heart attack, stroke, and death. Patients with high levels of non-HDL cholesterol may benefit from optimized preventive therapy.
KW - Aged
KW - Biomarkers/blood
KW - Denmark/epidemiology
KW - Diabetes Mellitus/blood
KW - Dyslipidemias/blood
KW - Female
KW - Heart Disease Risk Factors
KW - Humans
KW - Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
KW - Male
KW - Middle Aged
KW - Registries
KW - Risk Assessment
KW - Risk Factors
KW - Secondary Prevention
KW - Time Factors
KW - Cardiovascular disease
KW - Statin
KW - Cholesterol
KW - Secondary prevention
KW - Residual cardiovascular risk
KW - Diabetes
UR - http://www.scopus.com/inward/record.url?scp=85201043685&partnerID=8YFLogxK
U2 - 10.1093/eurjpc/zwae119
DO - 10.1093/eurjpc/zwae119
M3 - Journal article
C2 - 38513361
SN - 2047-4873
VL - 31
SP - 1238
EP - 1248
JO - European Journal of Preventive Cardiology
JF - European Journal of Preventive Cardiology
IS - 10
ER -