Lower levels of high-density lipoprotein cholesterol are associated with increased cardiovascular events in patients with acute coronary syndrome.

BACKGROUND AND AIMS

This study aimed to elucidate whether high-density lipoprotein cholesterol (HDL-C) at 3-month follow-up for patients receiving contemporary lipid-lowering therapy after acute coronary syndrome (ACS) could predict cardiac events.

METHODS

The HIJ-PROPER study was a multicenter, prospective, randomized trial comparing intensive lipid-lowering therapy (pitavastatin + ezetimibe) and conventional lipid-lowering therapy (pitavastatin monotherapy) after ACS. The entire cohort was divided into three groups according to tertiles of HDL-C levels at 3-month follow-up (Group 1, HDL-C ≤43 mg/dL; Group 2, HDL-C >43, <53.6 mg/dL; Group 3; HDL-C ≥53.6 mg/dL). Baseline characteristics and incidence of the primary endpoint (a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, unstable angina pectoris, or ischemia-driven revascularization) were compared among the three groups.

RESULTS

The primary endpoint event occurred in 34.8%, 30.1%, and 24.6% of patients in Groups 1, 2, and 3, respectively, and its incidence was significantly higher in Group 1 than in Group 3 (hazard ratio [HR], 1.5; 95% confidence interval [CI], 1.19-1.9; p = 0.001). Irrespective of the treatment regimen, Group 1 had significantly higher rates of the primary endpoint than Group 3 (pitavastatin + ezetimibe therapy: HR, 1.6; 95% CI, 1.12-2.22; p = 0.01 and pitavastatin monotherapy: HR, 1.4; 95% CI, 1.05-1.98; p = 0.02). These trends remained even after adjustment for baseline characteristics and lipid profiles. Multivariate analysis revealed that lower body mass index, prevalence of diabetes mellitus, higher levels of high-sensitivity C reactive protein at baseline, and lower levels of HDL-C at 3-month follow-up were independent predictors of the incidence of primary endpoint.

CONCLUSIONS

Lower levels of HDL-C at 3-month follow-up are independently associated with higher incidence of cardiovascular events in ACS patients receiving contemporary lipid-lowering therapy.

Informations de copyright

Copyright © 2020 Elsevier B.V. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of competing interest The authors have the following disclosures: all members of the HIJ-PROPER study group have received research support to perform clinical trials from the Japan Research Promotion Society for Cardiovascular Diseases, which is sponsored by Abbott Vascular Japan Co., Ltd., AstraZeneca K.K., Bayer Yakuhin Ltd., Boston Scientific Corporation, Bristol-Myers K.K., Daiichi Sankyo Co., Ltd., Kowa Pharmaceutical Co., Ltd., Mochida Pharmaceutical Co., Ltd., MSD K.K., Nippon Boehringer Ingelheim Co., Ltd., Novartis Pharma K.K., Pfizer Japan Inc., Sanofi K.K., and Takeda Pharmaceutical Co., Ltd. NH reports honoraria from Bristol-Myers K.K. and Nippon Boehringer Ingelheim Co., Ltd., and grants from Astellas Pharma Inc., Daiichi-Sankyo, Eisai Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Otsuka Pharmaceutical Co., Ltd., Shionogi & Co., Ltd., and Takeda Pharmaceutical Co., Ltd. JY belongs to the Clinical Research Division for Cardiovascular Catheter Intervention, which is financially maintained by donations from Abbott Vascular, Boston Scientific, Medtronic, and Terumo. The HIJ-PROPER Steering Committee had full access to all data of the present study and had final responsibility for the decision to submit for publication.