所属 医学部 医学科（東京女子医科大学病院） 職種 特任教授
|発表タイトル||The Impact of Decreased High-Density LipoproteinCholesterol Level After Lipid-lowering Therapy on the Clinical Outcomes in Patients With Acute Coronary Syndrome and Dyslipidemia: A Subanalysis of the HIJ-PROPER Study|
|会議名||ACC.18 (67th Annual Scientific Session & Expo)|
|主催者||American College of Cardiology|
|発表者・共同発表者||SEKIGUCHI Haruki, ◎MATSUI Yuko, WATANABE Erisa, YAMAGUCHI Junichi, ARASHI Hiroyuki, OGAWA Hiroshi, HAGIWARA Nobuhisa|
|学会抄録||Journal of the American College of Cardiology 71(11),Supplement A1758 2018|
|概要||Background: Well-controlled low-density lipoprotein-cholesterol (LDL-C) levels are important for secondary prevention of coronary artery disease, particularly in the setting of acute coronary syndrome (ACS). However, the association between other conventional lipid measures and major cardiovascular adverse events (MACEs) in patients with ACS who are receiving aggressive lipid-lowering therapy for dyslipidemia is unknown. We aimed to compare the association between changes in high-density lipoprotein-cholesterol (HDL-C) level at enrollment and 3 months after treatment and the occurrence of MACEs (a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, unstable angina, or any coronary revascularization) in patients with ACS after contemporary aggressive lipid-lowering therapy.
Methods: This is a subanalysis of the HIJ-PROPER study, which investigated the effect of aggressive LDL-C-lowering therapy with statin and ezetimibe in 1734 patients with ACS and concomitant dyslipidemia. The patients were grouped according to HDL-C level at enrollment and 3 months after treatment. We defined high HDL-C level (High) as ≥40 mg/dl and low HDL-C level (Low) as <40 mg/dl at two time points. Thus, among the High-High, High-Low, Low-High, and Low-Low groups, we performed a log-rank analysis of MACEs. The primary end point was a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, unstable angina, and ischemia-driven revascularizations.
Results: We evaluated 1483 patients who had HDL-C levels measured at 3 months without any cardiovascular events. The median followup period was 3.9 years, with a follow-up rate of 99%. During follow-up, 444 events (29.9%) were observed. The High-Low group showed a significantly higher event rate (41.2%) than the other groups (p<0.05). However, the event rate was not the highest in the Low-Low group (30.1%) and was not significantly lower in the High-High group (28.7%) than in the other groups.
Conclusion: Our subanalysis of data from the HIJ-PROPER study revealed that the decrease in HDL-C level was strongly associated with MACEs in patients with ACS who were receiving aggressive lipid-lowering therapy.