Recent publications on Residual Risk

There is a growing body of evidence supporting atherogenic dyslipidaemia, the combination of elevated fasting triglycerides and low plasma concentration of high-density lipoprotein cholesterol (HDL-C), as a contributor to residual cardiovascular risk. Added to this, this prospective cohort study showed that the nonfasting triglycerides/HDL-C ratio could be a valuable predictor of cardiovascular events after percutaneous coronary intervention (PCI) in patients treated with statins.
 
The study enrolled 1170 patients with acute coronary syndrome or stable angina between January 2005 and December 2015, who subsequently continued statin therapy after successful PCI. Patients were categorised on the basis of a nonfasting TG/HDL-C ratio 3 months after PCI: 1.37 ± 0.38 (group 1, n=390), 2.60 ±0.34 (group 2, n=390) and 5.60 ± 2.29 (group 3, n=390). The three groups did not differ with respect to high intensity statin use (73-76% of patients). The primary endpoint was major adverse cardiovascular events (MACE), defined as cardiac death, nonfatal myocardial infarction, or revascularization due to new stenosis or restenosis.
 
Over a median follow-up of 47 months, there was a higher incidence of MACE in the group with the highest nonfasting TG/HDL-C ratio: 156 (40.0%) versus 73 (18.7%) in Group 1 and 114 (29.2%) in Group 2. Cox proportional hazards regression analysis indicated that the nonfasting TG/HDL-C ratio was significantly correlated with the incidence of MACE (1.09, 95% confidence interval 1.05-1.13, p<0.001). In conclusion, this study shows that the nonfasting TG/HDL-C ratio is a valuable predictor of incident cardiovascular events after PCI in statin-treated patients. Ideally, clinicians should aim for a nonfasting TG/HDL-C ratio less than 2.00 in this patient group.