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Low high-density lipoprotein cholesterol is not a risk factor for recurrent vascular events in patients with vascular disease on intensive lipid-lowering medication.
J Am Coll Cardiol 2013; 62(20):1834-41JACC

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.

Authors+Show Affiliations

Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23948286

Citation

van de Woestijne, Anton P., et al. "Low High-density Lipoprotein Cholesterol Is Not a Risk Factor for Recurrent Vascular Events in Patients With Vascular Disease On Intensive Lipid-lowering Medication." Journal of the American College of Cardiology, vol. 62, no. 20, 2013, pp. 1834-41.
van de Woestijne AP, van der Graaf Y, Liem AH, et al. Low high-density lipoprotein cholesterol is not a risk factor for recurrent vascular events in patients with vascular disease on intensive lipid-lowering medication. J Am Coll Cardiol. 2013;62(20):1834-41.
van de Woestijne, A. P., van der Graaf, Y., Liem, A. H., Cramer, M. J., Westerink, J., & Visseren, F. L. (2013). Low high-density lipoprotein cholesterol is not a risk factor for recurrent vascular events in patients with vascular disease on intensive lipid-lowering medication. Journal of the American College of Cardiology, 62(20), pp. 1834-41. doi:10.1016/j.jacc.2013.04.101.
van de Woestijne AP, et al. Low High-density Lipoprotein Cholesterol Is Not a Risk Factor for Recurrent Vascular Events in Patients With Vascular Disease On Intensive Lipid-lowering Medication. J Am Coll Cardiol. 2013 Nov 12;62(20):1834-41. PubMed PMID: 23948286.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Low high-density lipoprotein cholesterol is not a risk factor for recurrent vascular events in patients with vascular disease on intensive lipid-lowering medication. AU - van de Woestijne,Anton P, AU - van der Graaf,Yolanda, AU - Liem,An-Ho, AU - Cramer,Maarten J M, AU - Westerink,Jan, AU - Visseren,Frank L J, AU - ,, Y1 - 2013/08/21/ PY - 2013/03/21/received PY - 2013/04/09/accepted PY - 2013/8/17/entrez PY - 2013/8/21/pubmed PY - 2014/1/8/medline KW - BMI KW - CETP KW - CI KW - HDL cholesterol KW - HDL-C KW - HR KW - LDL cholesterol KW - LDL-C KW - TG KW - body mass index KW - cholesteryl ester transfer protein KW - confidence interval KW - hazard ratio KW - high-density lipoprotein-cholesterol KW - low-density lipoprotein-cholesterol KW - secondary prevention KW - statins KW - triglycerides SP - 1834 EP - 41 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 62 IS - 20 N2 - 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. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/23948286/Low_high_density_lipoprotein_cholesterol_is_not_a_risk_factor_for_recurrent_vascular_events_in_patients_with_vascular_disease_on_intensive_lipid_lowering_medication_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(13)03083-0 DB - PRIME DP - Unbound Medicine ER -