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Target non-HDL-C to reduce residual cardiovascular risk factors in diabetes

This study from Taiwan provides valuable insights into the relevance of different residual cardiovascular risk factors in a prospective cohort of 5,483 patients with atherosclerotic cardiovascular disease (ASCVD), of whom 2,117 (39%) had diabetes. Overall, mean age was 66.4 years, 73% were male and 89% had coronary heart disease. Patients with diabetes were more likely to be older, female, have higher systolic blood pressure, and a higher rate of coronary artery disease and prior intervention for coronary or peripheral artery disease (p<0.05). At baseline, 69.5% of diabetes patients versus 65.5% of those without diabetes were treated with a statin (p<0.01), although the use of high-intensity statin did not differ between the two groups (<5%).
Compared with patients without diabetes, those with diabetes had lower levels of low-density lipoprotein cholesterol (LDL-C, mean ± SD: 92.7 ± 31.8 vs. 100.6 ± 35.1 mg/dL) and non-high-density lipoprotein cholesterol (non-HDL-C, 121.6 ± 37.5 vs. 126.9 ± 37.2 mg/dL), but higher triglycerides (152.2 ± 109.7 vs. 135.1 ± 83.4 mg/dL, all p < 0.001).
Over a median follow-up of 2.7 years, the incidence of recurrent major adverse cardiovascular events (MACE) was 1.6 per 100 person-years in diabetes patients versus 1.0 per 100 person-years in those without diabetes. The non-HDL-C level was the most significant lipid predictor among the lipid profile for recurrent MACE in patients with diabetes, irrespective of statin treatment. In diabetes patients treated with a statin, a non-HDL-C level between 100 and <130 mg/dl was associated with nearly 3-fold higher residual risk compared with those with a level <100 mg/dl (Hazard ratio 2.98, 95% CI 1.15-7.71, p<0.05), and those with a value of ?130 mg/dl had more than 4-fold higher risk. In conclusion, the study reinforces the need for improved lipid management, especially of non-HDL-C, a marker of total atherogenic apolipoprotein B-containing lipoproteins, in diabetes patients treated with a statin to reduce residual cardiovascular risk.
Residual risk factors to predict major adverse cardiovascular events in atherosclerotic cardiovascular disease patients with and without diabetes mellitus.

Lin FJ, Tseng WK, Yin WH, Yeh HI, Chen JW, Wu CC.