Low high-density lipoprotein cholesterol is not a risk factor for recurrent vascular events in patients with vascular disease on intensive lipid-lowering medication

Anton P van de Woestijne, Yolanda van der Graaf, An-Ho Liem, Maarten J M Cramer, Jan Westerink, Frank L J Visseren,

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVES: This study sought to evaluate the vascular risk of low high-density lipoprotein-cholesterol (HDL-C) in relation to the use and intensity of lipid-lowering medication in patients with clinically manifest vascular diseases.

BACKGROUND: Low levels of HDL-C are associated with an increased risk for vascular diseases and may contribute to residual vascular risk in patients already treated for other risk factors. However, post-hoc analyses from statin trials indicate that the vascular risk associated with low HDL-C may be low or even absent in patients using intensive statin therapy.

METHODS: We performed a prospective cohort study of 6,111 patients with manifest vascular disease. Cox proportional hazards models were used to evaluate the risk of HDL-C on vascular events in patients using no, usual dose, or intensive lipid-lowering therapy.

RESULTS: New vascular events (myocardial infarction, stroke, or vascular death) occurred in 874 subjects during a median follow-up of 5.4 years (interquartile range: 2.9 to 8.6 years). In patients not using lipid-lowering medication at baseline (n = 2,153), a 0.1 mmol/l increase in HDL-C was associated with a 5% reduced risk for all vascular events (hazard ratio [HR]: 0.95; 95% confidence interval [CI]: 0.92 to 0.99). In patients on usual dose lipid-lowering medication (n = 1,910) there was a 6% reduced risk (HR: 0.94; 95% CI: 0.90 to 0.98). However, in patients using intensive lipid-lowering treatment (n = 2,046), HDL-C was not associated with recurrent vascular events (HR: 1.02; 95% CI: 0.98 to 1.07) irrespective of low-density lipoprotein cholesterol level.

CONCLUSIONS: In patients with clinically manifest vascular disease using no or usual dose lipid-lowering medication, low plasma HDL-C levels are related to increased vascular risk, whereas in patients using intensive lipid-lowering medication, HDL-C levels are not related to vascular risk.

Original languageEnglish
Pages (from-to)1834-1841
Number of pages8
JournalJournal of the American College of Cardiology
Volume62
Issue number20
DOIs
Publication statusPublished - 12 Nov 2013

Keywords

  • Aged
  • Anticholesteremic Agents
  • Cholesterol, HDL
  • Cholesterol, LDL
  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Male
  • Middle Aged
  • Myocardial Ischemia
  • Netherlands
  • Proportional Hazards Models
  • Prospective Studies
  • Recurrence
  • Risk Factors
  • Journal Article
  • Research Support, Non-U.S. Gov't

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