Dataset Information

High-density lipoprotein cholesterol as a therapeutic target for residual risk in patients with acute coronary syndrome.

ABSTRACT:

Objective

The current guideline recommends lowering low-density lipoprotein cholesterol (LDL-C) for the primary management of dyslipidemia in patients at high-risk of cardiovascular events. Patients who have achieved LDL-C levels below the recommended targets may still experience cardiovascular events, suggesting additional therapeutic targets beyond LDL-C. The aim of this study was to investigate whether high-density lipoprotein cholesterol (HDL-C) levels had an impact on plaque stabilization in patients with acute coronary syndrome (ACS).

Methods

This study consisted of 90 ACS patients with untreated dyslipidemia. In optical coherence tomography (OCT) analysis, a plaque with fibrous cap thickness ?160 ?m was defined as a high-risk plaque. We registered one high-risk plaque per one patient by baseline OCT imaging, and then administrated high-intensity statin. Based on the follow-up OCT results, patients whose registered plaque was no longer high-risk plaque were classified into a responder group and the remains into a non-responder group.

Results

No differences were observed in the baseline LDL-C and HDL-C levels between the two groups. Reduction of LDL-C levels (? LDL-C: -53 ± 21 mg/dL vs. -42 ± 29 mg/dL, p = 0.036) and increase of HDL-C levels (? HDL-C: 2.5 ± 5.9 mg/dL vs. -0.3 ± 6.7 mg/dL, p = 0.039) were greater in the responder group. On multivariate logistic regression analysis, ? LDL-C levels (OR: 0.956, 95% CI: 0.921-0.993; p = 0.020) and ? HDL-C levels (OR: 1.143; 95% CI: 1.005-1.300, p = 0.041) were independent contributors for plaque stabilization.

Conclusions

Increase of HDL-C levels is associated with plaque stabilization in patients with ACS. HDL-C could be a therapeutic target for residual risk management.

SUBMITTER: Ozaki Y

PROVIDER: S-EPMC6040709 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Publications

High-density lipoprotein cholesterol as a therapeutic target for residual risk in patients with acute coronary syndrome.

Ozaki Yuichi Y Tanaka Atsushi A Nishiguchi Tsuyoshi T Komukai Kenichi K Taruya Akira A Satogami Keisuke K Kashiwagi Manabu M Kuroi Akio A Matsuo Yoshiki Y Ino Yasushi Y Kitabata Hironori H Kubo Takashi T Hozumi Takeshi T Akasaka Takashi T

PloS one 20180711 7

<h4>Objective</h4>The current guideline recommends lowering low-density lipoprotein cholesterol (LDL-C) for the primary management of dyslipidemia in patients at high-risk of cardiovascular events. Patients who have achieved LDL-C levels below the recommended targets may still experience cardiovascular events, suggesting additional therapeutic targets beyond LDL-C. The aim of this study was to investigate whether high-density lipoprotein cholesterol (HDL-C) levels had an impact on plaque stabili ...[more]

PMID: 29995934

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Project description:BackgroundChemically measured high-density lipoprotein cholesterol (HDL-C) may not be the best clinical measure of HDL. Little is known about alternative HDL measures such as HDL size or particle number (HDL-P) as determinants of residual risk after potent statin therapy.Methods and resultsIn Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER), HDL size and HDL-P were measured by nuclear magnetic resonance spectroscopy, and HDL-C and apolipoprotein A-I (apoA-I) were chemically assayed in 10 886 participants without cardiovascular disease (CVD) before and after random allocation to rosuvastatin 20 mg/d or placebo. Levels were examined with first CVD (n=234). HDL-P correlated better with apoA-I (Spearman r=0.69, P<0.0001) than with HDL-C (r=0.55, P<0.0001). Rosuvastatin lowered low-density lipoprotein cholesterol (49%) and raised HDL-C (6.1%), apoA-I (2.1%), HDL-P (3.8%), and HDL size (1.2%); all P<0.0001. Among placebo-allocated individuals, on-treatment HDL-C, apoA-I, and HDL-P had similar inverse associations with CVD (risk factor-adjusted hazard ratio and 95% confidence interval per 1 standard deviation: 0.79 [0.63-0.98], 0.75 [0.62-0.92], and 0.81 [0.67-0.97], respectively). Among rosuvastatin-allocated individuals, on-treatment HDL-P had a statistically significant and somewhat stronger association with CVD (0.73, 0.57-0.93, P=0.01) than HDL-C (0.82, 0.63-1.08, P=0.16) or apoA-I (0.86, 0.67-1.10, P=0.22). Among rosuvastatin-allocated individuals, on-treatment HDL-P remained significant (0.72, 0.53-0.97, P=0.03) after additionally adjusting for HDL-C. In risk factor-adjusted models, HDL size showed no significant association with CVD.ConclusionsIn the setting of potent statin therapy, HDL particle number may be a better marker of residual risk than chemically measured HDL-C or apoA-I. This has potential implications for evaluating novel therapies targeting HDL.Clinical trial registration urlhttp://www.clinicaltrials.gov. Unique identifier: NCT00239681.

Dataset Information

High-density lipoprotein cholesterol as a therapeutic target for residual risk in patients with acute coronary syndrome.

Objective

Methods

Results

Conclusions

Publications

High-density lipoprotein cholesterol as a therapeutic target for residual risk in patients with acute coronary syndrome.

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