Recent publications on Residual Risk

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.