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Diabetes associated residual atherosclerotic cardiovascular risk in statin-treated patients with prior atherosclerotic cardiovascular disease
Open accessAbstract
Aim In statin-treated persons with atherosclerotic cardiovascular disease (ASCVD) the further ASCVD risk that diabetes mellitus (DM) adds is not well-quantified. We examined this residual risk for initial and total recurrent ASCVD events. Methods We studied 3271 patients with ASCVD on statin therapy in the AIM-HIGH clinical trial cohort. Cox regression and the Prentice, Williams, and Peterson model examined the excess risk of initial and total recurrent ASCVD events associated with DM over a 3- year mean follow-up. Predictors of first and total ASCVD events in those with and without DM were also examined. Results Of our cohort with ASCVD on statin therapy 40% also had DM. Those with vs. without DM were older, were less likely to be male or white. They had higher systolic blood pressure, lower HDL-C, LDL-C, lipoprotein (a), but higher triglycerides and BMI (all p < 0.01). Adjusted HRs were 1.21 (95% CI; 1.01-1.46, p = 0.038) and 1.23 (95% CI: 1.05-1.44, p = 0.012) for first and total recurrent ASCVD events, respectively. Homocysteine and lipoprotein(a) most strongly predicted events in those with and without DM, respectively. Conclusion In statin-treated patients with ASCVD, DM was associated with significantly greater residual risk over ASCVD alone for both first and total recurrent ASCVD events.
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The PROMINENT data further highlight the complexity of lipid mediators of residual risk among patients with insulin resistance who are receiving statin therapy.
“Thus, our data further highlight the complexity of lipid mediators of residual risk among patients with insulin resistance who are receiving statin therapy. 6,23-25”
From Triglyceride Lowering with Pemafibrate to Reduce Cardiovascular Risk (2022) · cites this paper as [25]
The Results and Discussion (page unavailable) report residual ASCVD risk in statin-treated patients with diabetes and identify lipoprotein(a) as a predictor of recurrent events. This supports a role for lipid-related risk, but the paper studies diabetes rather than insulin resistance broadly and does not establish lipid mediation of that residual risk. The citing sentence’s reference to “our data” is the citing authors’ own conclusion, not a claim about this source. (LLM, conf=0.83)
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Triglyceride Lowering with Pemafibrate to Reduce Cardiovascular Risk
Das Pradhan, A., Glynn, R. J., Fruchart, J.-C., MacFadyen, J. G., Zaharris, E. S., Everett, B. M., Campbell, S. E., Oshima, R., Amarenco, P., Blom, D. J., et al. (2022) · New England Journal of Medicine · doi:10.1056/nejmoa2210645 · Cited by 749
Metadata
- Authors
- Zhao, Y., Xiang, P., Coll, B., López, J. A. G., & Wong, N. D.
- Affiliations
- University of California, Los Angeles (US)
- Amgen (United States) (US)
- Corresponding author
- Wong, Nathan D.
- Venue
- Journal of Diabetes and its Complications
- Publisher
- Elsevier BV
- Published
- 2021-03
- Volume
- 35
- Issue
- 3
- Pages
- 107767
- ISSN
- 0891-6632 (ISSN-L)
- 1056-8727
- PMC
- PMC7870509
- OpenAlex
- W3093566498
- Cited by
- 19
- References
- 0
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 3 · 2023: 6 · 2022: 3 · 2021: 1
- FWCI
- 2.51
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Diabetes and its Complications (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health
- Amgen
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Coronary Interventions and Diagnostics
- Keywords
- diabetes mellitus, residual cardiovascular risk, atherosclerotic cardiovascular disease, statin therapy, recurrent cardiovascular events, risk prediction, homocysteine, lipoprotein(a), AIM-HIGH trial, cardiovascular risk factors
- MeSH terms
- Heart Disease Risk Factors, Cardiovascular Diseases, Diabetes Mellitus, Female, Humans, Male, Risk Factors, Cohort Studies, Lipoprotein(a), Risk Assessment, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Diabetes Complications, Atherosclerosis
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