Prognostic effect of high-density lipoprotein cholesterol level in patients with atherosclerotic cardiovascular disease under statin treatment

• Published in: Scientific reports Vol. 10; no. 1; pp. 21835 - 9
• Main Authors: Li, Yi-Heng, Tseng, Wei-Kung, Yin, Wei-Hsian, Lin, Fang-Ju, Wu, Yen-Wen, Hsieh, I-Chang, Lin, Tsung-Hsien, Sheu, Wayne Huey-Herng, Yeh, Hung-I, Chen, Jaw-Wen, Wu, Chau-Chung
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 14.12.2020; Nature Publishing Group; Nature Portfolio
• Subjects: 692/4019; 692/499; Aged; Arteriosclerosis; Atherosclerosis; Body weight; Cardiovascular disease; Cardiovascular diseases; Cerebral infarction; Cholesterol; Cholesterol, HDL - blood; Coronary Artery Disease - blood; Coronary Artery Disease - diagnosis; Coronary Artery Disease - drug therapy; Coronary Artery Disease - epidemiology; Diabetes mellitus; Female; Follow-Up Studies; High density lipoprotein; Humanities and Social Sciences; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Male; Middle Aged; multidisciplinary; Myocardial infarction; Myocardial Infarction - blood; Myocardial Infarction - diagnosis; Myocardial Infarction - drug therapy; Myocardial Infarction - epidemiology; Observational studies; Prognosis; Prospective Studies; Registries; Risk Factors; Science; Science (multidisciplinary); Statins; Stroke - blood; Stroke - diagnosis; Stroke - drug therapy; Stroke - epidemiology; Taiwan
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-020-78828-8

In patients with atherosclerotic cardiovascular disease (ASCVD) under statin treatment, the influence of on-treatment level of high-density lipoprotein cholesterol (HDL-C) on cardiovascular (CV) events is controversial. Statin-treated patients were selected from the Taiwanese Secondary Prevention for patients with AtheRosCLErotic disease (T-SPARCLE) Registry, a multicenter, observational study of adult patients with ASCVD in Taiwan. Low HDL-C was defined as < 40 mg/dL for men and < 50 mg/dL for women. The primary outcome was a composite CV events including CV death, myocardial infarction (MI), stroke or cardiac arrest with resuscitation. A total of 3731 patients (mean age 65.6 years, 75.6% men) were included. Patients with on-treatment low HDL-C (44%, mean HDL-C 34.9 ± 6.8 mg/dL) were younger and with more diabetes and higher body weight. The mean follow-up time was 2.7 years. We used restricted cubic spline curves to examine the potential non-linear association between HDL-C and adverse outcomes. Decreased HDL-C levels were associated with a significantly increased risk of CV events in women (< 49 mg/dL in women) but not in men (< 42 mg/dL in men). However, the protective effect of elevated HDL-C levels was more prominent in men than in women. In ASCVD patients with statin therapy, low on-treatment HDL-C was common in Taiwan and associated with an increased risk of CV events in women. Higher HDL-C levels provided more protective effect in men than in women.