CAD progression linked to non-HDL-C changes

Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Coronary artery disease (CAD) progression seems more tightly linked to changes in non-high-density lipoprotein cholesterol (non-HDL-C) than to those in low-density lipoprotein cholesterol (LDL-C).

Study design

  • Researchers analyzed data from 9 clinical trials involving patients with CAD undergoing serial intravascular ultrasonography (n=4957) to compare changes in percent atheroma volume (ΔPAV) with lower vs higher on-treatment non-HDL-C and triglyceride (TG) levels.

  • Funding sources for the study were not disclosed.

Key results

  • Lower on-treatment non-HDL-C and TG levels were associated with significant PAV regression compared with higher non-HDL-C and TG levels across all levels of LDL-C and C-reactive protein and irrespective of diabetic status (P<.001 across all comparisons).

  • ΔPAV were more strongly influenced by changes in non-HDL-C (β=0.62; P<.001) compared with changes in LDL-C (β=0.51; P<.001).

  • Kaplan-Meier sensitivity analyses demonstrated significantly greater major adverse cardiovascular event rates in those with higher vs lower non-HDL-C and TG levels.

Limitations

  • The study examined patients with established CAD with an indication for coronary angiography; findings cannot be generalized to patients without clinically evident atherosclerotic disease.

Why this matters

  • A considerable portion of patients with statin-lowered LDL-C experience subsequent cardiovascular events, indicative of residual cardiovascular risk.