Residual cardiovascular risk in patients with stable coronary heart disease over the last 16 years (Czech part of the EUROASPIRE I–IV surveys)

Abstract

IntroductionMany patients with coronary heart disease (CHD) who achieve target low density lipoprotein cholesterol (LDL-C) values still experience vascular events because of a residual vascular risk due to other risk factors, particularly non-LDL-C dyslipidemia, because of non-adherence to non-pharmacological and pharmacological management. Method and aimsWe used simple markers and inexpensive screening tools for metabolic disorders associated with insulin resistance and metabolic syndrome identifying subjects at a high cardiovascular (CV) risk – atherogenic dyslipidemia [triglycerides (TG) ≥2.0mmol/l and high-density lipoprotein cholesterol (HDL-C) ≤1.0mmol/l in males and ≤1.2mmol/l in females], hypertriglyceridemic waist (TG ≥2.0mmol/l and waist circumference ≥90cm in males and ≥85cm in females), atherogenic index of plasma [AIP=log (TG/HDL-C)] and non-HDL-C (non-HDL-C=total cholesterol−HDL-C)]. We focused on the development of these risk factors among patients with established stable CHD over more than the last 16 years. ResultsWe examined 1484 patients, 1152 males (78%) and 332 females (22%) from the Czech parts of EUROASPIRE I–IV (EA I–IV) surveys. In males, TG, HDL-C, and non-HDL-C decreased significantly from EA I to IV (p for trends NS; 0.0001; 0.0001, respectively). In females, there was no change in TG; HDL-C, and non-HDL-C decreased significantly (p for trends NS; 0.03; 0.0001, respectively). Atherogenic dyslipidemia prevalence decreased significantly in both sexes (p for trends 0.004 and 0.0012, respectively). Hypertriglyceridemic waist prevalence showed no change in either sex. There were no significant changes in AIP risk strata in either sex. About 30–40% of males and 24–30% of females had their AIP in the high-risk strata, which tended to increase in males. The prevalence of type 2 diabetes (T2DM) and waist circumference increased significantly from EAI to IV (from 23% to 48%, and from 98cm to 105cm, respectively; both p for trend <0.0001). The prevalence of all above mentioned residual vascular risk markers was higher in patients with T2DM and impaired fasting glucose than in those with normal fasting glucose in both sexes. ConclusionDespite the increase in T2DM prevalence and waist circumference from EA I to IV, hypertriglyceridemic waist prevalence showed no change and atherogenic dyslipidemia prevalence decreased significantly in both sexes, because not all obese patients are insulin-resistant and not all patients with glucose metabolism disorders present all characteristics of metabolic syndrome. Simple markers of the atherogenic phenotype, especially AIP, should be used in CV risk assessment.