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).
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).
Authors: Anders G Olsson; Gregory G Schwartz; Michael Szarek; William J Sasiela; Michael D Ezekowitz; Peter Ganz; Michael F Oliver; David Waters; Andreas Zeiher Journal: Eur Heart J Date: 2005-03-11 Impact factor: 29.983
Authors: William E Boden; Jeffrey L Probstfield; Todd Anderson; Bernard R Chaitman; Patrice Desvignes-Nickens; Kent Koprowicz; Ruth McBride; Koon Teo; William Weintraub Journal: N Engl J Med Date: 2011-11-15 Impact factor: 91.245
Authors: F M Sacks; M A Pfeffer; L A Moye; J L Rouleau; J D Rutherford; T G Cole; L Brown; J W Warnica; J M Arnold; C C Wun; B R Davis; E Braunwald Journal: N Engl J Med Date: 1996-10-03 Impact factor: 91.245
Authors: Philip J Barter; Mark Caulfield; Mats Eriksson; Scott M Grundy; John J P Kastelein; Michel Komajda; Jose Lopez-Sendon; Lori Mosca; Jean-Claude Tardif; David D Waters; Charles L Shear; James H Revkin; Kevin A Buhr; Marian R Fisher; Alan R Tall; Bryan Brewer Journal: N Engl J Med Date: 2007-11-05 Impact factor: 91.245
Authors: J R Downs; M Clearfield; S Weis; E Whitney; D R Shapiro; P A Beere; A Langendorfer; E A Stein; W Kruyer; A M Gotto Journal: JAMA Date: 1998-05-27 Impact factor: 56.272
Authors: J Shepherd; S M Cobbe; I Ford; C G Isles; A R Lorimer; P W MacFarlane; J H McKillop; C J Packard Journal: N Engl J Med Date: 1995-11-16 Impact factor: 91.245
Authors: C Baigent; L Blackwell; J Emberson; L E Holland; C Reith; N Bhala; R Peto; E H Barnes; A Keech; J Simes; R Collins Journal: Lancet Date: 2010-11-08 Impact factor: 79.321
Authors: Daniel Seung Kim; Amber A Burt; Jane E Ranchalis; Simona Vuletic; Tomas Vaisar; Wan-Fen Li; Elisabeth A Rosenthal; Weijiang Dong; Jason F Eintracht; Arno G Motulsky; John D Brunzell; John J Albers; Clement E Furlong; Gail P Jarvik Journal: J Lipid Res Date: 2015-05-25 Impact factor: 5.922
Authors: Edna Maria Vissoci Reiche; Jair Roberto Gelinksi; Daniela Frizon Alfieri; Tamires Flauzino; Marcio Francisco Lehmann; Maria Caroline Martins de Araújo; Marcell Alysson Batisti Lozovoy; Andrea Name Colado Simão; Elaine Regina Delicato de Almeida; Michael Maes Journal: Metab Brain Dis Date: 2019-03-14 Impact factor: 3.584
Authors: Marilia C O Sprandel; Whady A Hueb; Alexandre Segre; José A F Ramires; Roberto Kalil-Filho; Raul C Maranhão Journal: Cardiovasc Diabetol Date: 2015-08-14 Impact factor: 9.951