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Low levels of high-density lipoprotein cholesterol and increased risk of cardiovascular events in stable ischemic heart disease patients: A post-hoc analysis from the COURAGE Trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation).
J Am Coll Cardiol. 2013 Nov 12; 62(20):1826-33.JACC

Abstract

OBJECTIVES

This study sought to assess the independent effect of high-density lipoprotein-cholesterol (HDL-C) level on cardiovascular risk in patients with stable ischemic heart disease (SIHD) who were receiving optimal medical therapy (OMT).

BACKGROUND

Although low HDL-C level is a powerful and independent predictor of cardiovascular risk, recent data suggest that this may not apply when low-density lipoprotein-cholesterol (LDL-C) is reduced to optimal levels using intensive statin therapy.

METHODS

We performed a post-hoc analysis in 2,193 men and women with SIHD from the COURAGE trial. The primary outcome measure was the composite of death from any cause or nonfatal myocardial infarction (MI). The independent association between HDL-C levels measured after 6 months on OMT and the rate of cardiovascular events after 4 years was assessed. Similar analyses were performed separately in subjects with LDL-C levels below 70 mg/dl (1.8 mmol/l).

RESULTS

In the overall population, the rate of death/MI was 33% lower in the highest HDL-C quartile as compared with the lowest quartile, with quartile of HDL-C being a significant, independent predictor of death/MI (p = 0.05), but with no interaction for LDL-C category (p = 0.40). Among subjects with LDL-C levels <70 mg/dl, those in the highest quintile of HDL-C had a 65% relative risk reduction in death or MI as compared with the lowest quintile, with HDL-C quintile demonstrating a significant, inverse predictive effect (p = 0.02).

CONCLUSIONS

In this post-hoc analysis, patients with SIHD continued to experience incremental cardiovascular risk associated with low HDL-C levels despite OMT during long-term follow-up. This relationship persisted and appeared more prominent even when LDL-C was reduced to optimal levels with intensive dyslipidemic therapy. (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation; NCT00007657).

Authors+Show Affiliations

Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

23973693

Citation

Acharjee, Subroto, et al. "Low Levels of High-density Lipoprotein Cholesterol and Increased Risk of Cardiovascular Events in Stable Ischemic Heart Disease Patients: a Post-hoc Analysis From the COURAGE Trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation)." Journal of the American College of Cardiology, vol. 62, no. 20, 2013, pp. 1826-33.
Acharjee S, Boden WE, Hartigan PM, et al. Low levels of high-density lipoprotein cholesterol and increased risk of cardiovascular events in stable ischemic heart disease patients: A post-hoc analysis from the COURAGE Trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation). J Am Coll Cardiol. 2013;62(20):1826-33.
Acharjee, S., Boden, W. E., Hartigan, P. M., Teo, K. K., Maron, D. J., Sedlis, S. P., Kostuk, W., Spertus, J. A., Dada, M., Chaitman, B. R., Mancini, G. B., & Weintraub, W. S. (2013). Low levels of high-density lipoprotein cholesterol and increased risk of cardiovascular events in stable ischemic heart disease patients: A post-hoc analysis from the COURAGE Trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation). Journal of the American College of Cardiology, 62(20), 1826-33. https://doi.org/10.1016/j.jacc.2013.07.051
Acharjee S, et al. Low Levels of High-density Lipoprotein Cholesterol and Increased Risk of Cardiovascular Events in Stable Ischemic Heart Disease Patients: a Post-hoc Analysis From the COURAGE Trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation). J Am Coll Cardiol. 2013 Nov 12;62(20):1826-33. PubMed PMID: 23973693.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Low levels of high-density lipoprotein cholesterol and increased risk of cardiovascular events in stable ischemic heart disease patients: A post-hoc analysis from the COURAGE Trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation). AU - Acharjee,Subroto, AU - Boden,William E, AU - Hartigan,Pamela M, AU - Teo,Koon K, AU - Maron,David J, AU - Sedlis,Steven P, AU - Kostuk,William, AU - Spertus,John A, AU - Dada,Marcin, AU - Chaitman,Bernard R, AU - Mancini,G B John, AU - Weintraub,William S, Y1 - 2013/08/21/ PY - 2013/03/25/received PY - 2013/07/08/revised PY - 2013/07/23/accepted PY - 2013/8/27/entrez PY - 2013/8/27/pubmed PY - 2014/1/8/medline KW - ACS KW - ATP KW - Adult Treatment Panel KW - BMI KW - CETP KW - HDL cholesterol KW - HDL-C KW - LDL-C KW - MI KW - OMT KW - PCI KW - SIHD KW - acute coronary syndrome(s) KW - body mass index KW - cholesteryl ester transfer protein KW - high-density lipoprotein cholesterol KW - low-density lipoprotein cholesterol KW - myocardial infarction KW - optimal medical therapy KW - percutaneous coronary intervention KW - residual risk KW - stable ischemic heart disease SP - 1826 EP - 33 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 62 IS - 20 N2 - OBJECTIVES: This study sought to assess the independent effect of high-density lipoprotein-cholesterol (HDL-C) level on cardiovascular risk in patients with stable ischemic heart disease (SIHD) who were receiving optimal medical therapy (OMT). BACKGROUND: Although low HDL-C level is a powerful and independent predictor of cardiovascular risk, recent data suggest that this may not apply when low-density lipoprotein-cholesterol (LDL-C) is reduced to optimal levels using intensive statin therapy. METHODS: We performed a post-hoc analysis in 2,193 men and women with SIHD from the COURAGE trial. The primary outcome measure was the composite of death from any cause or nonfatal myocardial infarction (MI). The independent association between HDL-C levels measured after 6 months on OMT and the rate of cardiovascular events after 4 years was assessed. Similar analyses were performed separately in subjects with LDL-C levels below 70 mg/dl (1.8 mmol/l). RESULTS: In the overall population, the rate of death/MI was 33% lower in the highest HDL-C quartile as compared with the lowest quartile, with quartile of HDL-C being a significant, independent predictor of death/MI (p = 0.05), but with no interaction for LDL-C category (p = 0.40). Among subjects with LDL-C levels <70 mg/dl, those in the highest quintile of HDL-C had a 65% relative risk reduction in death or MI as compared with the lowest quintile, with HDL-C quintile demonstrating a significant, inverse predictive effect (p = 0.02). CONCLUSIONS: In this post-hoc analysis, patients with SIHD continued to experience incremental cardiovascular risk associated with low HDL-C levels despite OMT during long-term follow-up. This relationship persisted and appeared more prominent even when LDL-C was reduced to optimal levels with intensive dyslipidemic therapy. (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation; NCT00007657). SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/23973693/Low_levels_of_high_density_lipoprotein_cholesterol_and_increased_risk_of_cardiovascular_events_in_stable_ischemic_heart_disease_patients:_A_post_hoc_analysis_from_the_COURAGE_Trial__Clinical_Outcomes_Utilizing_Revascularization_and_Aggressive_Drug_Evaluation__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(13)03082-9 DB - PRIME DP - Unbound Medicine ER -