Abstract 11840: Serum Apolipoprotein E Levels Predict Residual Cardiovascular Risk in Patients With Chronic Coronary Syndrome Undergoing First Percutaneous Coronary Intervention and On-Statin Treatment

Abstract

Background: Little is known about the long-term impact of apolipoprotein E (apoE) on residual cardiovascular risk in the patients with chronic coronary syndrome (CCS) receiving statin treatment. Methods: A total of 1109 consecutive patients (mean age, 67±10 years; 83% men) with CCS who underwent their first intervention between 2000 and 2016 were included in this study. All patients had achieved LDL-C <100 mg/dL on statin treatment, as target value recommended by the guidelines at that time, and were divided into two groups based on median serum apoE value. We evaluated the incidence of major adverse cardiovascular events (MACEs), including cardiovascular death, non-fatal acute coronary syndrome, and target vessel revascularization. Results: A total of 552 and 557 patients were categorized to the higher, and lower apoE groups, respectively. There were significant relationships between apoE levels and total cholesterol levels, triglyceride levels, high-density lipoprotein cholesterol levels and estimated remnant cholesterol except for LDL-C levels. During the median follow-up period of 5.1 years, 195 patients (17.6%) developed MACEs. Kaplan-Meier analysis revealed that the cumulative incidence of MACEs in the higher apoE group was significantly higher than in the lower apoE group (29.5% vs.23.8% log-rank test, p =0.019). On multivariable Cox hazard analysis, serum apoE level (1-mg/dL increase) (hazard ratio 1.15; 95% confidence interval 1.03-1.29, p =0.013) was a most strongly independent predictor of MACEs. Furthermore, after adjustment for various confounders including TG, HDL-C, LDL-C, and traditional cardiovascular risk factors, the higher apoE group was significantly associated with an increased risk of MACEs compared with the lower apoE group (p =0.008). Conclusions: Serum ApoE level could be a strong predictor and residual cardiovascular risk in patients with CCS on long-term, even if controlled LDL-C levels with statin treatment.