Low Levels of High-Density Lipoprotein Cholesterol and Increased Risk of Cardiovascular Events in Stable Ischemic Heart Disease Patients A Post-Hoc Analysis From the COURAGE Trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation)

被引：77

作者：

Acharjee, Subroto ^{[1
]}

Boden, William E. ^{[2
,3
]}

Hartigan, Pamela M. ^{[4
,5
]}

Teo, Koon K. ^{[6
]}

Maron, David J. ^{[7
]}

Sedlis, Steven P. ^{[8
,9
]}

Kostuk, William ^{[10
]}

Spertus, John A. ^{[11
,12
]}

Dada, Marcin ^{[13
,14
]}

Chaitman, Bernard R.

Mancini, G. B. John ^{[15
]}

Weintraub, William S. ^{[16
]}

机构：

[1] Albert Einstein Med Ctr, Philadelphia, PA 19141 USA

[2] Samuel S Stratton VA Med Ctr, Albany, NY USA

[3] Albany Med Coll, Albany, NY 12208 USA

[4] Coordinating Ctr, Cooperat Studies Program, West Haven, CT USA

[5] VA Connecticut Hlth Care Syst, West Haven, CT USA

[6] McMaster Univ, Med Ctr, Hamilton, ON, Canada

[7] Vanderbilt Univ, Med Ctr, Nashville, TN USA

[8] Vet Affairs VA New York Harbor Hlth Care Syst, New York, NY USA

[9] NYU, Sch Med, New York, NY USA

[10] London Hlth Sci Ctr, London, ON, Canada

[11] St Lukes Hosp, Mid Amer Heart Inst, Kansas City, MO 64111 USA

[12] Univ Missouri, Kansas City, MO 64110 USA

[13] Hartford Hosp, Hartford, CT 06115 USA

[14] St Louis Univ, St Louis, MO 63103 USA

[15] Univ British Columbia, Vancouver, BC V5Z 1M9, Canada

[16] Christiana Care Hlth Syst, Newark, DE USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2013年 / 62卷 / 20期

基金：

加拿大健康研究院;

关键词：

HDL cholesterol; residual risk; stable ischemic heart disease; RANDOMIZED CONTROLLED-TRIAL; ACUTE CORONARY SYNDROMES; OPTIMAL MEDICAL THERAPY; HDL CHOLESTEROL; STATIN THERAPY; PRIMARY PREVENTION; LDL CHOLESTEROL; METAANALYSIS; FRAMINGHAM; EFFICACY;

D O I：

10.1016/j.jacc.2013.07.051

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

Objectives This study sought to assess the independent effect of high-density lipoprotein-cholesterol (HDL-C) level on cardiovascular risk in patients with stable ischemic heart disease (SIHD) who were receiving optimal medical therapy (OMT). Background Although low HDL-C level is a powerful and independent predictor of cardiovascular risk, recent data suggest that this may not apply when low-density lipoprotein-cholesterol (LDL-C) is reduced to optimal levels using intensive statin therapy. Methods We performed a post-hoc analysis in 2,193 men and women with SIHD from the COURAGE trial. The primary outcome measure was the composite of death from any cause or nonfatal myocardial infarction (MI). The independent association between HDL-C levels measured after 6 months on OMT and the rate of cardiovascular events after 4 years was assessed. Similar analyses were performed separately in subjects with LDL-C levels below 70 mg/dl (1.8 mmol/l). Results In the overall population, the rate of death/MI was 33% lower in the highest HDL-C quartile as compared with the lowest quartile, with quartile of HDL-C being a significant, independent predictor of death/MI (p = 0.05), but with no interaction for LDL-C category (p = 0.40). Among subjects with LDL-C levels < 70 mg/dl, those in the highest quintile of HDL-C had a 65% relative risk reduction in death or MI as compared with the lowest quintile, with HDL-C quintile demonstrating a significant, inverse predictive effect (p = 0.02). Conclusions In this post-hoc analysis, patients with SIHD continued to experience incremental cardiovascular risk associated with low HDL-C levels despite OMT during long-term follow-up. This relationship persisted and appeared more prominent even when LDL-C was reduced to optimal levels with intensive dyslipidemic therapy. (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation; NCT00007657) (C) 2013 by the American College of Cardiology Foundation

引用

页码：1826 / 1833

页数：8

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