title: Predictors of residual cardiovascular risk in patients on statin therapy for primary prevention.
abstract: BACKGROUND
  Low-density lipoprotein cholesterol-lowering therapy is an important aspect of primary prevention of cardiovascular disease (CVD). Statins are the most widely used drug therapy for achieving low-density lipoprotein goals based on an individual's 10-year risk. However, substantial risk of CVD events still exists even when a person is on statins. We sought to explore the predictors of future CVD events in individuals on statins with no pre-existing CVD.
  
  
  METHODS
  The analysis was done on subjects who were on statins (n = 919) at baseline in the Multi-Ethnic Study of Atherosclerosis limited access dataset from the National Heart, Lung and Blood Institute. The primary outcome variable was all-cause CVD events (n = 67). Multivariate regression Cox proportional hazard analysis was done to identify potential independent predictors of all-cause CVD.
  
  
  RESULTS
  Our cohort consisted of 47% males, with a mean age of 66 ± 9 years. Sixty-seven participants (7.3%) experienced CVD events during a mean follow-up of 4.4 years. A higher coronary artery calcium score, homocysteine levels, waist circumference and a lower large arterial elasticity index were identified as independent predictors of CVD events.
  
  
  CONCLUSIONS
  Homocysteine, waist circumference, coronary artery calcification and the large artery elasticity index appear to be the major independent predictors of CVD events in individuals on statins with no pre-existing CVD. In addition to emphasizing weight loss, alternative approaches beyond lipid reduction may need to be explored to better characterize and attenuate the residual risk in subjects on statin therapy for primary prevention.
authors.affiliation: Divisions of Cardiology, Wayne State University, Detroit Medical Center, Mich., USA. lafonso @ med.wayne.edu
authors.forename: Luis
authors.initials: L
authors.lastname: Afonso
authors.forename: Vikas
authors.initials: V
authors.lastname: Veeranna
authors.forename: Sandip
authors.initials: S
authors.lastname: Zalawadiya
authors.forename: Krithi
authors.initials: K
authors.lastname: Ramesh
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Niraj
authors.forename: Sidakpal
authors.initials: S
authors.lastname: Panaich
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology*; D008078:Cholesterol, LDL / Q000097:blood*; D003324:Coronary Artery Disease / Q000150:complications; D004548:Elasticity; D005260:Female; D006710:Homocysteine / Q000378:metabolism; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention; D012307:Risk Factors; D061205:Vascular Calcification / Q000150:complications; D059289:Vascular Stiffness / Q000502:physiology; D055105:Waist Circumference
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D006710:Homocysteine