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Prognostic effect of high-density lipoprotein cholesterol level in patients with atherosclerotic cardiovascular disease under statin treatment.

Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan. arthurtseng@me.com. Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan. arthurtseng@me.com. National Yang Ming University School of Medicine, Taipei, Taiwan. Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan. Graduate Institute of Clinical Pharmacy and School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan. Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan. Cardiology Division, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan. Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan. Cardiology Division, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan. Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Division of Endocrinology and Metabolism and Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan. Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Mackay Medical College, New Taipei City, Taiwan. Institute of Pharmacology, National Yang Ming University, Taipei, Taiwan. Cardiology Division, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. chauchungwu@ntu.edu.tw. Graduate Institute of Medical Education and Bioethics, College of Medicine, National Taiwan University, Taipei, Taiwan. chauchungwu@ntu.edu.tw.

Scientific reports. 2020;(1):21835
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Abstract

In patients with atherosclerotic cardiovascular disease (ASCVD) under statin treatment, the influence of on-treatment level of high-density lipoprotein cholesterol (HDL-C) on cardiovascular (CV) events is controversial. Statin-treated patients were selected from the Taiwanese Secondary Prevention for patients with AtheRosCLErotic disease (T-SPARCLE) Registry, a multicenter, observational study of adult patients with ASCVD in Taiwan. Low HDL-C was defined as < 40 mg/dL for men and < 50 mg/dL for women. The primary outcome was a composite CV events including CV death, myocardial infarction (MI), stroke or cardiac arrest with resuscitation. A total of 3731 patients (mean age 65.6 years, 75.6% men) were included. Patients with on-treatment low HDL-C (44%, mean HDL-C 34.9 ± 6.8 mg/dL) were younger and with more diabetes and higher body weight. The mean follow-up time was 2.7 years. We used restricted cubic spline curves to examine the potential non-linear association between HDL-C and adverse outcomes. Decreased HDL-C levels were associated with a significantly increased risk of CV events in women (< 49 mg/dL in women) but not in men (< 42 mg/dL in men). However, the protective effect of elevated HDL-C levels was more prominent in men than in women. In ASCVD patients with statin therapy, low on-treatment HDL-C was common in Taiwan and associated with an increased risk of CV events in women. Higher HDL-C levels provided more protective effect in men than in women.

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Publication Type : Clinical Trial ; Multicenter Study

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