Factors predicting cardiovascular events in statin-treated diabetic and non-diabetic patients with coronary atherosclerosis.
OBJECTIVE
We aimed at identifying which lipid factors drive vascular risk in statin-treated patients with coronary artery disease (CAD).


METHODS
We recorded vascular events over 5.6 years in 491 consecutive statin-treated patients with angiographically proven stable CAD, covering 2750 patient-years.


RESULTS
In the total population, low high-density lipoprotein (HDL) cholesterol (standardized adjusted HR 0.73 [0.60-0.89]; p=0.001), low apolipoprotein A1 (0.77 [0.65-0.92]; p=0.003), a small low-density lipoprotein (LDL) particle diameter (0.76 [0.64-0.91]; p=0.002), and high triglycerides (1.20 [1.05-1.38]; p=0.007) predicted vascular events, but not total cholesterol, LDL cholesterol, or apolipoprotein B. Factor analysis in the lipid profiles of our patients revealed an HDL-related factor and an LDL-related factor. Concordant with the results for individual lipid parameters, the HDL-related factor (0.69 [0.58-0.83]; p<0.001) but not the LDL-related factor (p=0.455) predicted vascular events. Patients with type 2 diabetes (T2DM; n=116) were at a higher vascular risk than non-diabetic subjects (38.6% vs. 24.1%; p<0.001), and like in the total population the HDL-related factor (0.59 [0.44-0.77]; p<0.001) but not the LDL-related factor (p=0.591) predicted vascular risk in diabetic patients.


CONCLUSIONS
The pattern of low HDL cholesterol, low apolipoprotein A1, small LDL particles, and high triglycerides drives vascular risk in statin-treated coronary patients, particularly in those with T2DM.
Drexel
Heinz
H
Vorarlberg Institute for Vascular Investigation and Treatment, Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6807 Feldkirch, Austria. vivit@lkhf.at
Aczel
Stefan
S
Marte
Thomas
T
Vonbank
Alexander
A
Saely
Christoph H
CH
D000368:Aged; D016632:Apolipoprotein A-I / Q000097:blood / Q000378:metabolism; D001055:Apolipoproteins B / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis*; D016022:Case-Control Studies; D008078:Cholesterol, LDL / Q000378:metabolism; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D048909:Diabetes Complications / Q000175:diagnosis; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology; D008077:Lipoproteins, LDL / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D014280:Triglycerides / Q000378:metabolism
D016632:Apolipoprotein A-I; D001055:Apolipoproteins B; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008077:Lipoproteins, LDL; D014280:Triglycerides