Atherogenic dyslipidemia and residual cardiovascular risk in statin-treated patients

Details

Serval ID
serval:BIB_200EB9F9E6C6
Type
Article: article from journal or magazin.
Collection
Publications
Title
Atherogenic dyslipidemia and residual cardiovascular risk in statin-treated patients
Journal
Stroke
Author(s)
Sirimarco G., Labreuche J., Bruckert E., Goldstein L. B., Fox K. M., Rothwell P. M., Amarenco P.
Working group(s)
Perform, Sparcl Investigators, Committees
ISSN
1524-4628 (Electronic)
ISSN-L
0039-2499
Publication state
Published
Issued date
05/2014
Peer-reviewed
Oui
Volume
45
Number
5
Pages
1429-36
Language
english
Notes
Sirimarco, Gaia
Labreuche, Julien
Bruckert, Eric
Goldstein, Larry B
Fox, Kim M
Rothwell, Peter M
Amarenco, Pierre
eng
095626/Wellcome Trust/United Kingdom
Research Support, Non-U.S. Gov't
Stroke. 2014 May;45(5):1429-36. doi: 10.1161/STROKEAHA.113.004229. Epub 2014 Apr 15.
Abstract
BACKGROUND AND PURPOSE: Treatment with statins reduces the rate of cardiovascular events in high-risk patients, but residual risk persists. At least part of that risk may be attributable to atherogenic dyslipidemia characterized by low high-density lipoprotein cholesterol (</=40 mg/dL) and high triglycerides (triglycerides>/=150 mg/dL). METHODS: We studied subjects with stroke or transient ischemic attack in the Prevention of Cerebrovascular and Cardiovascular Events of Ischemic Origin With Terutroban in Patients With a History of Ischemic Stroke or Transient Ischemic Attack (PERFORM; n=19,100) and Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL; n=4731) trials who were treated with a statin and who had high-density lipoprotein cholesterol and triglycerides measurements 3 months after randomization (n=10,498 and 2900, respectively). The primary outcome measure for this exploratory analysis was the occurrence of major cardiovascular events (nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death). We also performed a time-varying analysis to account for all available high-density lipoprotein cholesterol and triglyceride measurements. RESULTS: A total of 10% of subjects in PERFORM and 9% in SPARCL had atherogenic dyslipidemia after >/=3 months on start statin therapy. After a follow-up of 2.3 years (PERFORM) and 4.9 years (SPARCL), a major cardiovascular event occurred in 1123 and 485 patients in the 2 trials, respectively. The risk of major cardiovascular events was higher in subjects with versus those without atherogenic dyslipidemia in both PERFORM (hazard ratio, 1.36; 95% confidence interval, 1.14-1.63) and SPARCL (hazard ratio, 1.40; 95% confidence interval, 1.06-1.85). The association was attenuated after multivariable adjustment (hazard ratio, 1.23; 95% confidence interval, 1.03-1.48 in PERFORM and hazard ratio, 1.24; 95% confidence interval, 0.93-1.65 in SPARCL). Time-varying analysis confirmed these findings. CONCLUSIONS: The presence of atherogenic dyslipidemia was associated with higher residual cardiovascular risk in PERFORM and SPARCL subjects with stroke or transient ischemic attack receiving statin therapy. Specific therapeutic interventions should now be trialed to address this residual risk.
Keywords
Aged, Cardiovascular Diseases/*epidemiology/mortality, Cholesterol, HDL/blood, Comorbidity, Dyslipidemias/blood/*epidemiology, Female, Follow-Up Studies, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use, Ischemic Attack, Transient/*drug therapy/epidemiology/prevention & control, Male, Middle Aged, Myocardial Infarction/epidemiology/mortality, Randomized Controlled Trials as Topic, Risk, Stroke/*drug therapy/epidemiology/prevention & control, Treatment Outcome, Triglycerides/blood, HMG-CoA reductase inhibitors, cardiovascular diseases, lipids, stroke
Pubmed
Open Access
Yes
Create date
28/02/2018 15:47
Last modification date
20/08/2019 13:55
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