Non-high-density lipoprotein cholesterol outperforms low-density lipoprotein cholesterol in predicting cardiovascular events among high-risk Asians

IF 4.6 3区医学 Q2 PHARMACOLOGY & PHARMACY Journal of clinical lipidology Pub Date : 2025-05-01 Epub Date: 2025-01-19 DOI:10.1016/j.jacl.2025.01.002

Worapaka Manosroi MD , Phichayut Phinyo MD , Mattabhorn Phimphilai MD , Pisit Hutayanon MD , Siriluck Gunaparn RN , Arintaya Phrommintikul MD , Wanwarang Wongcharoen MD

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Abstract

BACKGROUND

Non-high-density lipoprotein cholesterol (non-HDL-C) has been reported to exhibit stronger associations with cardiovascular (CV) outcomes compared to low-density lipoprotein cholesterol (LDL-C). However, data on this association, particularly among Asians using statins, are limited. This study aimed to compare the predictability of non-HDL-C and LDL-C on long-term 3-point major adverse cardiac events (3P-MACE) in statin-treated patients.

METHODS

Data from patients with atherosclerotic cardiovascular disease (ASCVD) or at high risk were obtained from the multicenter national registry, “CORE-Thailand study.” The primary outcome was 3P-MACE, including all-cause mortality, nonfatal myocardial infarction, and nonfatal stroke. Patients were stratified into quartiles based on non-HDL-C and LDL-C levels, and Cox proportional hazards regression models were used to analyze their association with 3P-MACE.

RESULTS

A total of 6978 with non-HDL-C data and 7365 with LDL-C data were included. In the fully adjusted model, overall non-HDL-C data and data from the highest quartile showed a significant association with 3P-MACE (hazard ratio [HR]: 1.008, 95% CI, 1.003-1.012, P < .001 and HR: 1.676, 95% CI, 1.218-2.307, P = .002, respectively). LDL-C did not exhibit a significant association with 3P-MACE. Interestingly, there was a trend suggesting that higher LDL-C levels were associated with a reduced risk of long-term MACE when adjusted for non-HDL-C. These findings were consistent across all population subgroups.

CONCLUSIONS

In patients with high-risk or established ASCVD receiving statin therapy, elevated non-HDL-C, rather than LDL-C, was associated with 3P-MACE. Non-HDL-C may therefore be considered a primary target for addressing residual CV risk in these individuals.

TRIAL REGISTRATION

TCTR20130520001 registered in Thai Clinical Trials Registry (TCTR) https://www.thaiclinicaltrials.org/, date of registration 20 May 2013.

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非高密度脂蛋白胆固醇在预测高危亚洲人心血管事件方面优于低密度脂蛋白胆固醇。

背景：据报道，与低密度脂蛋白胆固醇（LDL-C）相比，非高密度脂蛋白胆固醇（non-HDL-C）与心血管结局的相关性更强。然而，关于这种关联的数据，特别是在使用他汀类药物的亚洲人中，是有限的。本研究旨在比较非hdl - c和LDL-C对他汀类药物治疗患者长期3点主要心脏不良事件（3P-MACE）的可预测性。方法：来自动脉粥样硬化性心血管疾病（ASCVD）或高危患者的数据来自多中心国家登记“core -泰国研究”。主要终点为3P-MACE，包括全因死亡率、非致死性心肌梗死和非致死性卒中。根据非hdl - c和LDL-C水平将患者分为四分位数，采用Cox比例风险回归模型分析其与3P-MACE的相关性。结果：共纳入非hdl - c数据6978例，LDL-C数据7365例。在完全调整的模型中，总体非hdl - c数据和最高四分位数的数据显示与3P-MACE显著相关（HR: 1.008, 95% CI, 1.003-1.012, P ）。结论：在接受他汀类药物治疗的高危或已确诊ASCVD患者中，非hdl - c升高与3P-MACE相关，而非LDL-C升高。因此，非hdl - c可能被认为是解决这些个体剩余心血管风险的主要目标。试验注册：TCTR20130520001在泰国临床试验注册中心（TCTR） https://www.thaiclinicaltrials.org/注册，注册日期为2013年5月20日。

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来源期刊

Journal of clinical lipidology 医学-药学

CiteScore

7.00

自引率

6.80%

发文量

209

审稿时长

49 days

期刊介绍： Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. Sections of Journal of clinical lipidology will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.