CAD progression linked to non-HDL-C changes

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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.