Lipid Markers Associated with Recurrent ACS in Patients Treated with Statins: LDL- Versus Non-HDL-cholesterol

Abstract

Introduction: Debate exists as to the relative utility of lipid markers in cardiovascular risk prediction. Lipid markers other than LDL-cholesterol have shown significant association with cardiac events, and may be of additional utility in the investigation and management of cardiovascular disease. Purpose: The purpose of this study is to evaluate and compare the association of LDL- and non-HDL-cholesterol with recurrence of ACS in patients treated with statins. Methods: Data were collected from subjects presenting to a large metropolitan hospital between 2009-2014 with recurrent ACS while on statin treatment. Subjects’ LDL-cholesterol (LDL-C) and non-HDL-cholesterol (non-HDL-C) levels were obtained and compared to established on-treatment target levels (<2.0mmol/L and <2.5mmol/L respectively). The proportion exceeding these targets was then calculated for each marker. These proportions were then subjected to statistical analysis to ascertain their association with recurrent ACS in patients treated with statins. Results: 226 patients on statin therapy following previous ACS were identified. Of these, 101 had recurrent ACS. 52.5% of these subjects’ LDL-C levels and 64% of non-HDL-C levels were in excess of their respective therapeutic targets. The relative risk of excessive LDL-C levels in this group of subjects was 1.106, while for non-HDL-C it was 1.77. Conclusion: In this population, non-HDL-C was more closely associated with recurrence of ACS in patients treated with statins than LDL-C. While this finding requires confirmation in larger-scale studies, it adds to evidence suggesting non-HDL-cholesterol may have a role in cardiovascular risk prediction among patients being treated with statins for ACS.