Abstract 12925: The Role of HDL Cholesterol in Patients With Atherosclerotic Cardiovascular Disease Under Statin Treatment.

Background: Low HDL-C is a common lipid phenotype in Asia. Although low HDL-C is a risk factor of atherosclerotic cardiovascular disease (ASCVD) in general population, it is controversial whether the on-treatment HDL-C level is still a predicting factor of cardiovascular (CV) events in ASCVD patients (pts) under statin treatment. Methods and Results: A total of 3,731 pts (age 65.6 yrs, 75% men) receiving statins were selected from the Taiwanese Secondary Prevention for patients with AtheRosCLErotic disease (T-SPARCLE) Registry, a multicenter, observational study of adult pts with stable coronary artery disease (CAD), cerebrovascular disease, or peripheral arterial disease in Taiwan. Low HDL-C was defined as < 40 mg/dL for male and < 50 mg/dL for female. The pts with low HDL-C (44%, mean HDL-C 34.9 ± 6.8 mg/dL) during statin treatment were younger and with more female, diabetes, CAD and higher body weight than pts with normal HDL-C. The primary outcome was a composite CV events including CV death, myocardial infarction (MI), stroke or cardiac arrest with resuscitation. The mean follow-up time was 2.7 years. Multivariate Cox proportional hazard analysis showed on-treatment low HDL-C was not an independent risk factor of primary outcome (normal vs. low HDL-C, hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.55-1.20) after adjusting multiple clinical factors. The risk of CV events was recalculated for each quintile of HDL-C. In the univariate model, the CV event rate decreased progressively by 23% from the lowest (< 35 mg/dL) to the highest (> 54 mg/dL) quintile of HDL-C. However, multivariate Cox proportional hazard analysis showed no significant relationships between quintiles of HDL-C levels and the risk of CV events (HDL-C < 35 [HR 1.50, 95% CI 0.82-2.76], 35 to 40.2 [HR 0.99, 95% CI 0.52-1.88], 40.2 to <46 [HR 1.07, 95% CI 0.58-1.99], 46 to < 54 [HR 1.09, 95% CI 0.59-2.01] vs. >54 mg/dL). Conclusions: In Taiwanese pts with ASCVD under statin therapy, low on-treatment HDL-C was not associated with increased risk of CV events. [ABSTRACT FROM AUTHOR]