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Determinants of residual risk in secondary prevention patients treated with high- versus low-dose statin therapy: the
Samia Mora1, Nanette K Wenger, David A Demicco
1Brigham and Women's Hospital, Boston, MA 02215, USA. smora@partners.org
Circulation
|March 31, 2012
Summary
Residual cardiovascular risk in statin-treated patients is linked to non-lipid factors like age, BMI, hypertension, and diabetes. A comprehensive prevention strategy is crucial for managing this residual risk effectively.
Area of Science:
- Cardiology
- Clinical Pharmacology
Background:
- Cardiovascular events persist in patients treated with statins, indicating a
- residual risk
- that requires further investigation.
- Risk factors for residual cardiovascular risk beyond lipid levels have not been comprehensively studied.
Purpose of the Study:
- To identify determinants of residual cardiovascular risk in patients receiving statin therapy.
- To investigate factors contributing to cardiovascular events beyond lipid-lowering effects of statins.
Main Methods:
- Analysis of 9251 coronary patients from the Treating to New Targets (TNT) study with low-density lipoprotein cholesterol <130 mg/dL.
- Multivariable analysis to identify determinants of major cardiovascular events during a median 4.9-year follow-up.
- Assessment of baseline characteristics, on-treatment lipids, and apolipoproteins as risk factors.
Main Results:
- Increased risk associated with older age, higher body mass index, male sex, hypertension, diabetes mellitus, elevated baseline apolipoprotein B, and blood urea nitrogen.
- Protective factors included high-dose statin therapy, aspirin use, and higher baseline apolipoprotein A-I.
- On-treatment lipid and apolipoprotein levels did not show additional association with risk.
Conclusions:
- Residual cardiovascular risk in statin-treated patients is influenced by both lipid-related and non-lipid factors, including baseline apolipoproteins, BMI, smoking, hypertension, and diabetes.
- A multifaceted prevention approach is essential to mitigate residual risk in secondary prevention patients.
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