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Cited by 57Lipoproteins and Cardiovascular HealthAcute Myocardial Infarction ResearchDiabetes, Cardiovascular Risks, and Lipoproteins

Non-HDL cholesterol and residual risk of cardiovascular events in patients with ischemic heart disease and well-controlled LDL cholesterol: a cohort study

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Hansen, Malene Kærslund, Mortensen, Martin Bødtker, Warnakula Olesen, Kevin Kris, Thrane, Pernille Gro, Maeng, Michael·2024·The Lancet Regional Health - Europe
DOI 10.1016/j.lanepe.2023.100774PMC PMC10652132
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Abstract

Background: Identifying patients at high residual risk of atherosclerotic cardiovascular disease (ASCVD) despite statin-treatment is of paramount clinical importance. We aim to investigate if non-high-density lipoprotein cholesterol (non-HDL-C) identifies residual risk of ASCVD and death in statin-treated patients with ischemic heart disease and low-density lipoprotein cholesterol (LDL-C) ≤ 1.8 mmol/L. Methods: Leveraging Danish regional and national registries, we identified statin-treated patients with ischemic heart disease who underwent coronary angiography (CAG) and attained LDL-C ≤ 1.8 mmol/L within a year post-CAG. Outcomes were myocardial infarction (MI), ASCVD (MI or ischemic stroke), and all-cause death occurring from one year after CAG to end of follow-up. Cox regression analyses obtained adjusted hazard ratios (HR). Findings: Between January 1, 2011, and December 31, 2020, we included 23,641 statin-treated patients with ischemic heart disease and LDL-C ≤ 1.8 mmol/L. During median follow-up of 4.1 years (IQR 2.4-6.1), 893 (3.8%) patients developed MI, 1207 (5.1%) ASCVD, and 3054 (12.9%) patients died. For ASCVD the adjusted HRs (95% confidence interval) for non-HDL-C < 25th percentile (<1.7 mmol/L) versus 25th-74th (1.7-2.1 mmol/L), 75th-94th (2.2-2.6 mmol/L), and ≥95th (≥2.7 mmol/L) percentile were 1.1 (0.9-1.3), 1.4 (1.1-1.7), and 1.8 (1.4-2.4), and for all-cause death 1.0 (0.9-1.1), 1.2 (1.1-1.4), and 1.4 (1.2-1.7), respectively. Interpretation: In a contemporary secondary prevention cohort of patients with well-managed LDL-C, non-HDL-C emerges as an easily accessible marker to detect patients facing high residual risk of ASCVD and death. These findings are important for preventive strategies extending beyond LDL-C targets. Funding: Research grant from the Novo Nordisk Foundation.

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Authors
Hansen, M. K., Mortensen, M. B., Warnakula Olesen, K. K., Thrane, P. G., & Maeng, M.
Affiliations
  • Aarhus University (DK)
  • Johns Hopkins University (US)
  • Aarhus University Hospital (DK)
Corresponding author
Hansen, Malene Kærslund
ORCID
Venue
The Lancet Regional Health - Europe
Publisher
Elsevier BV
Published
2024-01
Volume
36
Pages
100774
ISSN
2666-7762 (ISSN-L)
DOI
10.1016/j.lanepe.2023.100774
PMC
PMC10652132
OpenAlex
W4388346149
Cited by
57
References
12
Citations by year
2026: 24 · 2025: 23 · 2024: 10
FWCI
15.27
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Regional Health - Europe (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
Novo Nordisk Fonden (NNF22OC0074083)
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
non-HDL cholesterol, residual cardiovascular risk, ischemic heart disease, statin-treated patients, LDL cholesterol, atherosclerotic cardiovascular disease, myocardial infarction, all-cause mortality, ischemic stroke, secondary prevention, coronary angiography, lipid control, risk stratification, hypertriglyceridemia, dyslipidemia, triglycerides

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