医学
糖尿病
内科学
他汀类
剩余风险
危险系数
心肌梗塞
心脏病学
比例危险模型
冲程(发动机)
内分泌学
置信区间
机械工程
工程类
作者
Malene Hansen,Martin Bødtker Mortensen,Kevin Kris Warnakula Olesen,Pernille Gro Thrane,Reimar Wernich Thomsen,Michael Mæng
标识
DOI:10.1093/eurjpc/zwae119
摘要
Abstract Aims Assessment of residual cardiovascular risk in statin-treated patients with atherosclerotic cardiovascular disease (ASCVD) is pivotal for optimizing secondary preventive therapies. This study investigates if non–high-density lipoprotein cholesterol (non-HDL-C) is associated with residual ASCVD risk in statin-treated ischaemic heart disease (IHD) patients with and without diabetes. Methods and results Using the Western Denmark Heart Registry, we identified statin-treated patients with IHD examined by coronary angiography (CAG) from 2011 to 2020. Non-HDL-C was assessed within 1 year after CAG. Outcomes were ASCVD (myocardial infarction, ischaemic stroke, and cardiovascular death) and all-cause death. Cox regression analyses obtained hazard ratios (HRs) adjusted for age, sex, smoking, and hypertension. A total of 42 057 patients were included: 8196 patients with diabetes and 33 861 without diabetes. During the median 4.6 years of follow-up, event rates per 1000 person-years of ASCVD were 28.8 (27.1–30.5) and 17.2 (16.5–17.8) among patients with and without diabetes. In patients with diabetes, the adjusted HRs of ASCVD as compared with non-HDL-C < 25th percentile were 1.0 (0.9–1.2), 1.3 (1.1–1.6), and 1.6 (1.2–2.1) for patients in the 25th–74th, 75th–94th, and ≥95th percentiles. In patients without diabetes, the corresponding adjusted HRs were 1.1 (0.9–1.1), 1.2 (1.1–1.4), and 1.7 (1.4–2.0). Results were consistent across sex, age, clinical presentation, and low-density lipoprotein cholesterol strata. Conclusion In statin-treated IHD patients with and without diabetes, non-HDL-C, especially above the 75th percentile, is associated with residual cardiovascular risk. These results have implications for secondary prevention, targeting patients who may benefit most from intensified preventive therapy.
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