{"title":"Non-high-density lipoprotein cholesterol outperforms low-density lipoprotein cholesterol in predicting cardiovascular events among high-risk Asians.","authors":"Worapaka Manosroi, Phichayut Phinyo, Mattabhorn Phimphilai, Pisit Hutayanon, Siriluck Gunaparn, Arintaya Phrommintikul, Wanwarang Wongcharoen","doi":"10.1016/j.jacl.2025.01.002","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Non-high-density lipoprotein cholesterol (non-HDL-C) has been reported to exhibit stronger associations with cardiovascular 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.</p><p><strong>Methods: </strong>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, non-fatal myocardial infarction, and non-fatal 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.</p><p><strong>Results: </strong>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 (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 MACEs when adjusted for non-HDL-C. These findings were consistent across all population subgroups.</p><p><strong>Conclusions: </strong>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 cardiovascular risk in these individuals.</p><p><strong>Trial registration: </strong>TCTR20130520001 registered in Thai Clinical Trials Registry (TCTR) https://www.thaiclinicaltrials.org/, date of registration 20 May 2013.</p>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of clinical lipidology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jacl.2025.01.002","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Non-high-density lipoprotein cholesterol (non-HDL-C) has been reported to exhibit stronger associations with cardiovascular 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, non-fatal myocardial infarction, and non-fatal 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 (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 MACEs 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 cardiovascular risk in these individuals.
Trial registration: TCTR20130520001 registered in Thai Clinical Trials Registry (TCTR) https://www.thaiclinicaltrials.org/, date of registration 20 May 2013.
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.
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