Predictive value of remnant lipoprotein for cardiovascular events in patients with coronary artery disease after achievement of LDL-cholesterol goals
Abstract
Objectives Triglycerides-rich lipoproteins are related to residual cardiovascular risk in patients on lipid-lowering treatment who achieve low-density lipoprotein cholesterol (LDL-C) goals. This study examined the predictive value of remnant lipoprotein levels for cardiovascular events in patients with coronary artery disease (CAD) with LDL-C levels <100mg/dL on lipid-lowering therapy.Methods Serum levels of remnant lipoproteins (remnant-like lipoprotein particles cholesterol; RLP-C) were measured by an immunoseparation method in 560 patients with CAD who had LDL-C levels <100mg/dL on lipid-lowering therapy, including statin (58%), fibrate (13%) or diet only (29%). All the patients were followed prospectively for a period of ≤ 36 months or until occurrence of one of the following events: cardiac death, non fatal myocardial infarction, unstable angina requiring coronary revascularization, or ischemic stroke.Results During a mean follow-up period of 33 months, 40 events occurred. Stepwise multivariate Cox proportional hazard analysis showed that RLP-C was a significant predictor of cardiovascular events after adjustment for known risk factors and lipid variables including triglycerides, non-high-density lipoprotein (HDL)-C, and total apolipoprotein B (HR 1.53, 95% CI 1.35-1.97, p<0.01). The c-statistics showed that addition of RLP-C had a greater incremental effect on the predictive value of conventional risk factors than addition of non-HDL-C or total apolipoprotein B.Conclusions RLP-C was superior to non-HDL-C for predicting cardiovascular events in CAD patients with LDL-C levels <100mg/dL on lipid-lowering treatment. Remnant lipoprotein may therefore be an important target for residual risk reduction after LDL-C goals on lipid lowering therapy.
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Hyper-remnant-lipoproteinemia is a risk factor for ASCVD.
“Hyper-remnant-lipoproteinemia is a risk factor for ASCVD. (Evidence level: E-1b)”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [239]
Hyper-remnant-lipoproteinemia is an independent risk factor even when LDL-C is maintained at < 100 mg/dL.
“In addition, hyper-remnant-lipoproteinemia is an independent risk factor even when LDL-C is maintained at < 100 mg/dL239, 240).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [239]
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- Authors
- Nakamura, T., Obata, J.-E., Hirano, M., Kitta, Y., Fujioka, D., Saito, Y., Kawabata, K.-I., Watanabe, K., Watanabe, Y., Mishina, H., & Kugiyama, K.
- Affiliations
- University of Yamanashi Hospital (JP)
- Corresponding author
- Kugiyama, Kiyotaka
- Venue
- Atherosclerosis
- Publisher
- Elsevier BV
- Published
- 2011-09
- Volume
- 218
- Issue
- 1
- Pages
- 163-167
- ISSN
- 0021-9150 (ISSN-L)
- OpenAlex
- W2032275737
- Cited by
- 83
- References
- 30
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 8 · 2023: 11 · 2022: 9 · 2021: 4 · 2020: 6 · 2019: 5 · 2018: 5 · 2017: 1 · 2016: 5 · 2015: 6 · 2014: 5 · 2013: 5 · 2012: 4
- FWCI
- 4.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Atherosclerosis (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Otsuka Pharmaceutical
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Keywords
- remnant lipoproteins, coronary artery disease, cardiovascular events, residual cardiovascular risk, LDL cholesterol targets, lipid-lowering therapy, non-HDL cholesterol, apolipoprotein B, triglyceride-rich lipoproteins, cardiovascular risk prediction, myocardial infarction, ischemic stroke, cardiovascular mortality
- MeSH terms
- Aged, Apolipoproteins B, Cardiology, Cardiovascular Diseases, Cholesterol, Coronary Artery Disease, Female, Follow-Up Studies, Humans, Lipoproteins, Cholesterol, HDL, Cholesterol, LDL, Male, Middle Aged, Predictive Value of Tests, Risk Factors, Triglycerides, Proportional Hazards Models
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