Discordance of Circulating Non-HDL Cholesterol with LDL Cholesterol Concerning Long-Term Prognosis in Statin-Treated Individuals with Acute Coronary Syndrome and Previous Coronary Artery Bypass Grafting Undergoing Percutaneous Coronary Intervention

TL;DR

This study shows that even with low LDL cholesterol, high non-HDL cholesterol can predict future heart problems in patients who have had bypass surgery and are on statins.

Contribution

The study introduces the clinical relevance of non-HDL-C/LDL-C discordance in predicting residual cardiovascular risk in statin-treated patients with prior CABG.

Findings

Non-HDL-C and LDL-C levels were both independent risk indicators for MACEs.

Discordant high non-HDL-C/low LDL-C levels were associated with a 2.44-fold higher risk of MACEs.

Non-HDL-C showed a linear relationship with MACEs, while LDL-C showed a nonlinear relationship.

Abstract

Some individuals who maintain desirable low-density
lipoprotein cholesterol (LDL-C) levels still experience the progression of
atherosclerosis, which may eventually lead to cardiovascular events.
Non-high-density lipoprotein cholesterol (non-HDL-C) levels are quantified to
assess residual risk in statin-treated patients with coronary heart disease. The
study aimed to estimate the predictive performance of discordance between
non-HDL-C and LDL-C on clinical prognosis in statin-treated patients with
previous coronary artery bypass grafting (CABG).

468
statin-treated patients with previous CABG undergoing percutaneous coronary
intervention (PCI) as a secondary coronary treatment due to acute coronary
syndrome (ACS) were retrospectively enrolled in this study. The definition of
major adverse cardiovascular events (MACEs) was a composite endpoint of
cardiovascular death, recurring myocardial infarction, and a need for repeat
revascularization. Cox proportional hazards modeling, restricted cubic splines
regression, and discordance analysis were conducted to the association between
all lipid parameters and the occurrence of MACEs. Discordant values were defined
as LDL-C concentrations ≤1.8 mmol/L accompanied by non-HDL-C >2.6
mmol/L.

MACEs occurred in 95 patients over a median follow-up
period of 744.5 days. Cox models demonstrated that increased concentrations of
non-HDL-C and LDL-C levels were independent risk indicators of MACEs (p
< 0.001). The restricted cubic spline analysis revealed a linear relationship
between non-HDL-C concentrations and MACEs (p-nonlinear: 0.26), whereas a
nonlinear relationship was observed between LDL-C concentrations and MACEs
(p
< 0.01). In the subgroup analysis, the spline curves revealed that
the odds of the individuals with desirable LDL-C levels suffering MACEs emerged
when non-HDL-C levels were above 2.07 mmol/L. Individuals who exhibited
discordance involving high non-HDL-C/low LDL-C levels had an elevated risk of
experiencing MACEs compared to those with concordantly low LDL-C and low
non-HDL-C levels [hazard ratios (HRs) = 2.44, 95% confidence interval (CI) =
1.14–5.22, p = 0.02].

Non-HDL-C levels could
predict the residual risk of MACEs in ACS patients with previous CABG and statin
therapy that underwent percutaneous coronary intervention. A discordance between
non-HDL-C and LDL-C in individuals with desirable LDL-C levels could be useful in
identifying those with a residual risk of cardiovascular complications.

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