Combined Triglyceride-High-density Lipoprotein Cholesterol Phenotypes and Cardiovascular Outcomes in Japanese...

Despite intensive lipid-lowering therapy, residual cardiovascular risk remains prevalent among patients with coronary artery disease. Although triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) metabolism are closely interrelated, their combined prognostic significance in secondary prevention remains unclear.

This study analyzed the Clinical Deep Data Accumulation System- Percutaneous Coronary Intervention (CLIDAS-PCI) database, a multicenter Japanese registry of patients with acute coronary syndrome undergoing PCI. Patients were stratified into four combined TG-HDL phenotypic groups using guideline-consistent cutoff values for high TG (≥ 175 mg/dL) and low HDL-C (≤ 40 mg/dL) levels. The primary outcome was a composite of major adverse cardiac and cerebrovascular events plus hospitalization for heart failure and its components.

Among 3,352 patients, high TG levels were not associated with the composite outcome but were consistently associated with an increased risk of recurrent myocardial infarction. Although low HDL-C levels were associated with increased cardiovascular risk, this association was attenuated after adjustment for renal function and nutritional status. Combined TG-HDL phenotyping revealed distinct risk profiles: patients with high TG and low HDL-C levels had the highest risk of recurrent myocardial infarction, while those with low TG and low HDL-C levels exhibited a markedly higher risk of cardiovascular death.

In a Japanese secondary prevention cohort undergoing PCI, TG and HDLC demonstrated complementary and outcome-specific prognostic associations. Thus, combined TG-HDL phenotyping using guideline-based cutoffs may provide a simple and clinically relevant approach to stratifying residual cardiovascular risk beyond low-density lipoprotein cholesterol lowering.