title: Role of non-high-density lipoprotein cholesterol in predicting cerebrovascular events in patients following myocardial infarction.
abstract: Although there appears to be a role for statins in reducing cerebrovascular events, the exact role of different lipid fractions in the etiopathogenesis of cerebrovascular disease (CVD) is not well understood. A secondary analysis of data collected for the placebo arm (n = 2,078) of the Cholesterol and Recurrent Events (CARE) trial was performed. The CARE trial was a placebo-controlled trial aimed at testing the effect of pravastatin on patients after myocardial infarction. Patients with histories of CVD were excluded from the study. A Cox proportional-hazards model was used to evaluate the association between plausible risk factors (including lipid fractions) and risk for first incident CVD in patients after myocardial infarction. At the end of 5 years, 123 patients (6%) had incident CVD after myocardial infarction (76 with stroke and 47 with transient ischemic attack). Baseline non-high-density lipoprotein (HDL) cholesterol level emerged as the only significant lipid risk factor that predicted CVD; low-density lipoprotein cholesterol and HDL cholesterol were not significant. The adjusted hazard ratios (adjusted for age, gender, hypertension, diabetes mellitus, and smoking) for CVD were 1.28 (95% confidence interval [CI] 1.06 to 1.53) for non-HDL cholesterol, 1.14 (95% CI 0.96 to 1.37) for low-density lipoprotein cholesterol, and 0.90 (95% CI 0.75 to 1.09) for HDL cholesterol (per unit SD change of lipid fractions). This relation held true regardless of the level of triglycerides. After adjustment for age and gender, the hazard ratio for the highest natural quartile of non-HDL was 1.76 (95% CI 1.05 to 2.54), compared to 1.36 (95% CI 0.89 to 1.90) for low-density lipoprotein cholesterol. In conclusion, non-HDL cholesterol is the strongest predictor among the lipid risk factors of incident CVD in patients with established coronary heart disease.
authors.affiliation: Department of Cardiology, Wayne State University, Detroit, Michigan, USA.
authors.forename: Nitin
authors.initials: N
authors.lastname: Mahajan
authors.forename: Brian A
authors.initials: BA
authors.lastname: Ference
authors.forename: Natasha
authors.initials: N
authors.lastname: Arora
authors.forename: Ramesh
authors.initials: R
authors.lastname: Madhavan
authors.forename: Pratik
authors.initials: P
authors.lastname: Bhattacharya
authors.forename: Rajeev
authors.initials: R
authors.lastname: Sudhakar
authors.forename: Amit
authors.initials: A
authors.lastname: Sagar
authors.forename: Yun
authors.initials: Y
authors.lastname: Wang
authors.forename: Frank
authors.initials: F
authors.lastname: Sacks
authors.forename: Luis
authors.initials: L
authors.lastname: Afonso
mesh_terms: D000368:Aged; D002561:Cerebrovascular Disorders / Q000097:blood / Q000175:diagnosis*; D002784:Cholesterol / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008074:Lipoproteins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy; D017035:Pravastatin / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008074:Lipoproteins; D014280:Triglycerides; C030104:lipoprotein cholesterol; D002784:Cholesterol; D017035:Pravastatin