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Atherogenic dyslipidemia and incident cardiovascular events in high-risk hypertension
Richard Kazibwe1, Jeshuah Jehopio2, Christopher L Schaich3
1Department of Internal Medicine, Wake Forest University School of Medicine, 1 Medical Center Medical Center Boulevard, Winston-Salem, NC 27157, USA.
Insights
Atherogenic dyslipidemia (AD), characterized by low HDL-C and high TG, significantly increases cardiovascular disease (CVD) risk in hypertensive patients. Early detection and management of AD are crucial for reducing long-term CVD events.
Area of Science:
- Cardiology
- Metabolic Disorders
- Hypertension Management
Background:
- Atherogenic dyslipidemia (AD), defined by low HDL-C and high TG, is a known risk factor for cardiovascular disease (CVD).
- Hypertension management strategies aim to mitigate CVD risk, but the specific impact of AD within these treatment arms requires further elucidation.
Purpose of the Study:
- To evaluate the association between Atherogenic Dyslipidemia (AD) and cardiovascular disease (CVD) risk.
- To compare the CVD risk in hypertensive patients with AD under intensive versus standard systolic blood pressure (SBP) lowering treatment targets.
Main Methods:
- Utilized data from 9361 participants in the Systolic Blood Pressure Intervention Trial (SPRINT).
- Classified participants into four lipid categories based on baseline HDL-C and TG levels, with AD defined as low HDL-C and high TG.
- Employed multivariable Cox regression to assess the relationship between lipid categories and the composite primary CVD outcome.
Main Results:
- Atherogenic dyslipidemia (AD) was associated with a 41% increased risk of major cardiovascular events (HR: 1.41; 95% CI: 1.12-1.77) compared to normal lipid profiles.
- Individuals with AD showed elevated CVD risk in both standard (HR: 1.38) and intensive (HR: 1.44) SBP-lowering groups.
- The incidence of primary CVD events was higher in participants with AD (9.5%) compared to those with normal HDL-C and TG (7.4%).
Conclusions:
- Atherogenic dyslipidemia (AD) is significantly associated with increased cardiovascular disease (CVD) risk in hypertensive individuals.
- Early identification of AD in hypertensive patients, irrespective of diabetes status, is recommended to intensify therapeutic efforts and reduce long-term CVD risk.
Background:
Atherogenic dyslipidemia (AD), characterized by low high-density lipoprotein cholesterol (HDL-C) and elevated triglycerides (TG), is associated with increased cardiovascular disease (CVD) risk. This study evaluates the association between AD and CVD in hypertension treated to systolic blood pressure (SBP) targets of <120 mmHg (intensive) or < 140 mmHg (standard).
Methods:
We included 9361 participants from the Systolic Blood Pressure Intervention Trial (SPRINT). Based on baseline lipid profiles, low HDL-C was defined as <40 mg/dL in men or < 50 mg/dL in women, and high TG as ≥150 mg/dL. Participants were classified into four lipid categories according to these cutoffs. AD was defined as the combination of low HDL-C and high TG. We used multivariable Cox regression to evaluate the association between lipid categories and the primary SPRINT outcome, a composite of major CVD events.
Results:
Over a median 3.8-year follow-up, 726 primary outcome events occurred. The incidence of the primary outcome was 9.5% (n = 104) in those with AD and 7.4% (n = 434) with normal HDL-C and TG. Compared to the reference group (normal HDL-C with normal TG), the hazard ratios (HRs) for primary outcome were 1.07 (95 % CI: 0.85-1.35) for high TG alone, 1.20 (95 % CI: 0.95-1.52) for low HDL-C alone, and 1.41 (95 % CI: 1.12-1.77) for AD. Similarly, HRs for the primary outcome associated with AD were 1.38 (95 % CI: 1.02-1.87) and 1.44 (95 % CI: 1.01-2.05) in the standard and intensive SBP-lowering arms, respectively.
Conclusion:
Among SPRINT participants, AD was associated with a higher CVD risk. Early detection of AD in hypertensive patients, even without diabetes, may prompt greater therapeutic effort to reduce long-term CVD risk.
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