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Role of Triglycerides and HDL Cholesterol in Residual Risk in Coronary Artery Disease Patients with low LDL Cholesterol
Session:
Posters - J. Preventive Cardiology
Speaker:
M. Raquel Santos
Congress:
CPC 2021
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.2 Risk Factors and Prevention – Cardiovascular Risk Assessment
Session Type:
Posters
FP Number:
---
Authors:
M. Raquel Santos; Maria Isabel Mendonça; Margarida Temtem; Flávio Mendonça; João Adriano; Ana Célia Sousa; Mariana Rodrigues; Eva Henriques; Sónia Freitas; Sofia Borges; Graça Guerra; António Drumond; Roberto Palma Dos Reis
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Introduction:</u></strong> Coronary atherosclerosis is crucial in the development of coronary artery disease (CAD). Low-density lipoprotein cholesterol (LDLc) is the main target as the cornerstone lipid cardiovascular risk factor. Triglycerides (TG) and high-density lipoprotein cholesterol (HDLc) are additional independent factors. Elevated triglycerides (TG) and low HDLc may increase cardiovascular risk in patients with LDLc under the goal.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Objective:</u></strong> The objective of this study was to determine whether elevated triglycerides (>150mg/dl) or low HDLc (<40mg/dl) are independently associated with cardiovascular complications in CAD patients with LDLc under 100 mg/dL</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u> Methods:</u></strong> The study involved 1712 coronary patients selected from GENEMACOR study population, with at least one major coronary artery >75% stenosis by angiography, median age 53.3 ± 7.9 years, 78.7% male. Biochemical analysis was determined, and a cohort of 736 patients with LDL-C <100mg/dl (mean age 54.4±7.6 and 76.9% men) was considered. Chi-square and T student tests were used to analyze the population´s demographic, laboratory, angiographic, and anthropometric characteristics according to LDLc<100mg/dL. Finally, we analysed whether, in this population with LDL within the goal, the existence of high triglycerides and low HDLc was associated with a worse prognosis, after the follow-up period. Adverse cardiovascular events (MACEs) were estimated by Multivariate Cox regression analysis, with a mean follow-up of 3.4±3.5 years.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Results:</u></strong> In our population the patients with HDLc < 40mg/dl were associated with MACEs in bivariate analysis; 57.4% vs 43.3%; p<0.0001. After Cox regression analysis adjusted to sex, age of event, smoking, hypertension, diabetes, and dyslipidemia. HDLc<40 remaining in the equation as an independent predictor of MACEs (HR 1.368; 95% CI <span style="color:#010205">1,065-1,758; p=0,014). In present study, e</span>levated triglycerides <span style="color:#010205">did not associate with MACEs in the follow-up.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Conclusion:</u></strong> Our population with patients under statin therapy with reasonably controlled LDL (<100mg/dl) the presence of low HDLc was independently associated with an adverse prognosis and higher occurrence of MACE. To date, there are no specific drugs available for the reduction of this maker of residual risk. So, more studies towards drugs affecting HDLc levels may indeed improve prognosis even in patients under statins. </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">It will be important to re-evaluate the influence of low HDL and high triglyceride levels in the prognosis of CAD patients with a more ambitious control of LDL (<55 mg/dL), according with current guidelines.</span></span></p>
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