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Published on: April 27, 2016
Effect of Novel Stratified Lipid Risk by "LDL-Window" and Flow-Mediated Dilation on the Prognosis of Coronary Artery
Shichiro Abe1, Yasuo Haruyama2,3, Gen Kobashi2,3
1Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine.
Insights
Elevated triglyceride and non-HDL cholesterol levels indicate residual cardiovascular risk. Stratifying this risk with flow-mediated dilation improves prediction of major adverse cardiovascular events in coronary artery disease patients.
Area of Science:
- Cardiology
- Lipidology
- Vascular Biology
Background:
- Elevated triglyceride (TG) and non-high-density lipoprotein cholesterol (non-HDL-C) represent residual cardiovascular risk during low-density lipoprotein cholesterol (LDL-C) lowering therapy.
- Understanding this residual risk is crucial for managing patients with coronary artery disease (CAD).
Purpose of the Study:
- To investigate the association between lipid risk, stratified by TG and non-HDL-C levels, and the prognosis of CAD patients.
- To examine the relationship between stratified lipid risk and the flow-mediated dilation (FMD) index.
Main Methods:
- 624 CAD patients were stratified into four groups based on TG (<150 mg/dL vs. ≥150 mg/dL) and non-HDL-C (<170 mg/dL vs. ≥170 mg/dL) levels.
- Major adverse cardiovascular events (MACE) and FMD index were assessed.
- Multivariable regression analysis was used to identify independent predictors of MACE.
Main Results:
- The cumulative incidence of 3-point MACE was significantly higher in the high-risk group (TG ≥150 mg/dL and non-HDL-C ≥170 mg/dL) (P=0.009).
- This association was significant in patients with an FMD index ≥7.0% (P=0.021) but not in those with FMD <7.0%.
- High lipid risk and FMD <7.0% were independently correlated with 3-point MACE incidence.
Conclusions:
- Novel stratification of lipid risk using TG and non-HDL-C levels is valuable for predicting cardiovascular outcomes in CAD patients.
- Combining this lipid risk stratification with FMD measurement enhances the prediction of cardiovascular events.
Background:
Elevated levels of triglyceride (TG) and non-high-density lipoprotein cholesterol (non-HDL-C) are regarded as a residual lipid risk in low-density lipoprotein cholesterol (LDL-C)-lowering therapy. This study investigated the association between lipid risk stratified by TG and non-HDL-C and the prognosis of patients with coronary artery disease (CAD), and the association between stratified lipid risk and flow-mediated dilatation (FMD) index.
Methods And Results:
The 624 CAD patients enrolled in flow-mediated dilation (FMD)-J study A were divided into 4 groups: low-risk group (n=413) with TG <150 mg/dL and non-HDL-C <170 mg/dL; hyper-TG group (n=180) with TG ≥150 mg/dL and non-HDL-C <170 mg/dL; hyper-non-HDL group (n=12) with TG <150 mg/dL and non-HDL-C ≥170 mg/dL; and high-risk group (n=19) with TG ≥150 mg/dL and non-HDL-C ≥170 mg/dL. Comparison of the groups showed the cumulative incidence of a 3-point major adverse cardiovascular event (MACE) was different and highest in the high-risk group in all the patients (P=0.009), and in patients with a FMD index ≥7.0% (P=0.021), but not in those with a FMD index <7.0%. Multivariable regression analysis showed that high lipid risk (P=0.019) and FMD <7.0% (P=0.040) were independently correlated with the incidence of a 3-point MACE.
Conclusions:
Novel stratification of lipid risk, simply using TG and non-HDL-C levels, combined with FMD measurement, is useful for predicting cardiovascular outcomes in patients with CAD.
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