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Association Between Very Low Levels of High-Density Lipoprotein Cholesterol and Long-term Outcomes of Patients With Acute Coronary Syndrome Treated Without Revascularization : Insights From the TRILOGY ACS Trial
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- Hagström, Emil (author)
- Uppsala universitet,Kardiologi
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- Roe, Matthew T. (author)
- Duke Univ, Sch Med, Duke Clin Res Inst, Div Cardiovasc Med, Durham, NC USA.
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- Hafley, Gail (author)
- Duke Univ, Sch Med, Duke Clin Res Inst, Dept Stat, Durham, NC USA.
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- Neely, Megan L. (author)
- Duke Univ, Sch Med, Duke Clin Res Inst, Dept Stat, Durham, NC USA.
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- Sidhu, Mandeep S. (author)
- Albany Stratton VA Med Ctr, Dept Med, Albany, NY USA. Albany Med Coll, Albany Med Ctr, Albany, NY 12208 USA.
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- Winters, Kenneth J. (author)
- Eli Lilly & Co, Indianapolis, IN 46285 USA.
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- Prabhakaran, Dorairaj (author)
- Ctr Chron Dis Control & Publ Hlth Fdn India, New Delhi, India.
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- White, Harvey D. (author)
- Auckland City Hosp, Green Lane Cardiovasc Serv, Auckland, New Zealand.
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- Armstrong, Paul W. (author)
- Univ Alberta, Canadian VIGOUR Ctr, Dept Med, Div Cardiol, Edmonton, AB, Canada.
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- Fox, Keith A. A. (author)
- Univ Edinburgh, Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland.
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- Ohman, Magnus (author)
- Duke Univ, Sch Med, Duke Clin Res Inst, Div Cardiovasc Med, Durham, NC USA.
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- Boden, William E. (author)
- Albany Stratton VA Med Ctr, Dept Med, Albany, NY USA. Albany Med Coll, Albany Med Ctr, Albany, NY 12208 USA.
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(creator_code:org_t)
- 2016-05-13
- 2016
- English.
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In: Clinical Cardiology. - : Wiley. - 0160-9289 .- 1932-8737. ; 39:6, s. 329-337
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Abstract
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- Background: Low levels of high-density lipoprotein cholesterol (HDL-C; < 40 mg/dL) are associated with increased risk of cardiovascular events, but it is unclear whether lower thresholds (< 30 mg/dL) are associated with increased hazard.Hypothesis: Very low levels of HDL-C may provide prognostic information in acute coronary syndrome (ACS) patients treated medically without revascularization.Methods: We examined data from 9064/9326 ACS patients enrolled in the TRILOGY ACS trial. Participants were randomized to clopidogrel or prasugrel plus aspirin. Study treatments continued for 6 to 30 months. Relationships between baseline HDL-C and the composite of cardiovascular death, myocardial infarction (MI), or stroke, and individual endpoints of death (cardiovascular and all-cause), MI, and stroke, adjusted for baseline characteristics through 30 months, were analyzed. The HDL-C was evaluated as a dichotomous variable-very low (< 30 mg/dL) vs higher (>= 30 mg/dL)-and continuously.Results: Median baseline HDL-C was 42mg/dL (interquartile range, 34-49mg/dL) with little variation over time. Frequency of the composite endpoint was similar for very low vs higher baseline HDL-C, with no risk difference between groups (hazard ratio [ HR]: 1.13, 95% confidence interval [ CI]: 0.95-1.34). Similar findings were seen for MI and stroke. However, risks for cardiovascular (HR: 1.42, 95% CI: 1.13-1.78) and all-cause death (HR: 1.36, 95% CI: 1.11-1.67) were higher in patients with very low baseline HDL-C.Conclusions: Medically managed ACS patients with very low baseline HDL-C levels have higher risk of long-term cardiovascular and all-cause death but similar risks for nonfatal ischemic outcomes vs patients with higher baseline HDL-C.
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- By the author/editor
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Hagström, Emil
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Roe, Matthew T.
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Hafley, Gail
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Neely, Megan L.
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Sidhu, Mandeep S ...
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Winters, Kenneth ...
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show more...
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Prabhakaran, Dor ...
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White, Harvey D.
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Armstrong, Paul ...
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Fox, Keith A. A.
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Ohman, Magnus
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Boden, William E ...
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Clinical Cardiol ...
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Uppsala University