Abstract
BackgroundResidual risk remained significant despite effective low density lipoprotein cholesterol (LDL-C) lowering treatment. Small dense low density lipoprotein cholesterol (sdLDL-C) as part of LDL-C has been found to be predictor of coronary heart disease (CHD) and cardiovascular (CV) events in patients with stable CHD independently of LDL-C. However, to date, few studies have explored the role of sdLDL-C in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). Accordingly, this study aimed to evaluate the association of sdLDL-C with CV events in patients with ACS undergoing PCI.MethodsPatients hospitalized with ACS undergoing PCI were enrolled and followed up for 18 months. The risk of sdLDL-C for CV events was compared according to sdLDL-C quartiles. The primary outcome was major cardiovascular and cerebrovascular adverse events (MACCE), which was the composite of all cause of death, nonfatal myocardial infarction (MI), nonfatal stroke or unplanned repeat revascularization. A Cox proportional hazards regression model was performed to estimate the risk of CV events. Subgroup analysis according to diabetes status and LDL-C were performed separately for MACCE.ResultsA total of 6092 patients were included in the analysis (age: 60.2 ± 10.13 years, male: 75.3%, BMI: 25.9 ± 3.33 kg/m2, dyslipidemia: 74.1% and diabetes: 44.5%). During 18 months of follow-up, 320 (5.2%) incident CV events occurred. Compared to the lowest sdLDL-C quartile group, patients in the highest quartile had a greater risk of CV events after multivariable adjustment (HR 1.92; 95% CI 1.37–2.70). In addition, it was mainly due to the increase of unplanned repeat revascularization. In the subgroup analyses, significant association was observed regardless of level of LDL-C and diabetes status.ConclusionsPatients with elevated sdLDL-C have a higher risk of CV events in Chinese patients with ACS undergoing PCI, providing additional value for better risk assessment.
Highlights
Death rates related to cardiovascular disease (CVD) have decreased, but it was still a leading cause of deaths as a result of aging, obesity and diabetes mellitus (DM) [1]
Residual risk remained significant despite effective low density lipoprotein cholesterol (LDL-C) lowering treatment in accordance with current guideline, including statin, ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) antibodies [4,5,6]
To date, few studies have explored the role of Small dense low density lipoprotein cholesterol (sdLDL-C) in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI)
Summary
Death rates related to cardiovascular disease (CVD) have decreased, but it was still a leading cause of deaths as a result of aging, obesity and diabetes mellitus (DM) [1]. Residual risk remained significant despite effective low density lipoprotein cholesterol (LDL-C) lowering treatment in accordance with current guideline, including statin, ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) antibodies [4,5,6]. Residual risk remained significant despite effective low density lipoprotein cholesterol (LDL-C) lowering treatment. Small dense low density lipoprotein cholesterol (sdLDL-C) as part of LDL-C has been found to be predictor of coronary heart disease (CHD) and cardiovascular (CV) events in patients with stable CHD independently of LDL-C. To date, few studies have explored the role of sdLDL-C in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI).
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