Introduction: The concepts of lipid management for patients with stable coronary artery disease (CAD) are different according to UA and European guidelines. Whether these guidelines could be applied to Asian patients with CAD are still unknown.
Hypothesis: Lower low-density lipoprotein-cholesterol (LDL-C) levels and higher high-density lipoprotein cholesterol (HDL-C) levels are associated with lower cardiovascular events in Asian patients with CAD.
Methods: This is a multicenter study conducted in 9 medical centers in Taiwan. A series of stable CAD patients who had undergone percutaneous coronary interventions were enrolled prospectively. All of them were divided into 3 LDL-C groups (< 70 mg/dL, 70 to < 100 mg/dL, and ≥ 100 mg/dL) and 3 HDL-C groups (< 40 mg/dL, 40 to < 50 mg/dL, and ≥ 50 mg/dL) according to achieved lipid profiles at baseline. All the patients were followed-up for adverse cardiovascular events in 12 months, including cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, unstable angina, peripheral arterial occlusive disorder, and hospitalization for heart failure.
Results: The study had enrolled a total of 2,045 patients. The mean age was 63.5 ± 11.9 years; 84.2% were male. Overall, cox regression showed no difference of total cardiovascular events in three LDL-C groups. In the type 2 diabetes mellitus subgroup, patients with LDL-C 70 to < 100 mg/dL (adjusted hazard ratio [HR], 2.907; 95% confidence interval [CI], 1.213-6.968, p= 0.017) and LDL ≥ 100 mg/dL (adjusted HR, 2.642; 95% CI, 1.072-6.513, p= 0.035) had higher risks of total cardiovascular events when compared to those with LDL-C < 70 mg/dL. In the no statins subgroup, patients with LDL-C 70 to < 100 mg/dL (adjusted HR, 10.087; 95% CI, 1.362-74.720, p= 0.024) and LDL ≥ 100 mg/dL (adjusted HR, 8.255; 95% CI, 1.101-61.892, p= 0.040) had higher risks of total cardiovascular events when compared to those with LDL-C < 70 mg/dL. For HDL-C, Cox regression revealed no difference in multivariate analysis.
Conclusions: For Asian CAD patients with type 2 diabetes mellitus and no statins use, achieved LDL-C < 70 mg/dL are associated with lower cardiovascular events.