Advertisement
Heart, Lung and Circulation

High Prevalence of Lipid-Related Residual Risk in ACS Patients

Published:October 27, 2021DOI:https://doi.org/10.1016/j.hlc.2021.10.006
      We audited 94 serial patients with acute coronary syndrome (ACS) on lipid-lowering therapy admitted to a coronary care unit in a Perth tertiary hospital to determine the prevalence of lipid-related residual risk of cardiovascular disease. Twenty-nine (29) patients presented with ST elevation myocardial infarction (STEMI), 49 with non ST elevation myocardial infarction (NSTEMI) and 16 with unstable angina. We recorded fasting plasma low-density lipoprotein cholesterol (LDL-C), triglycerides, lipoprotein (a) [Lp(a)], and remnant cholesterol (REM-C) concentrations (total cholesterol minus HDL-C and LDL-C) [
      • Langsted A.
      • Madsen C.M.
      • Nordestgaard B.G.
      Contribution of remnant cholesterol to cardiovascular risk.
      ]. The key findings were (Figure 1):
      • 1.
        Sixty-six (66) (70.2%) of the patients were male, with 42.6% having premature coronary artery disease (<60 years of age).
      • 2.
        Fifty-one (51) (54.3%) had elevated LDL-C (≥2 mmol/L), and 47 (50%) elevated triglycerides (≥ 1.7 mmol/L), and 59 (62.8%) reduced HDL-C (<1 mmol/L).
      • 3.
        Twenty-nine (29) (30.9%) had elevated plasma Lp(a), (≥105 nmol/L), and 38 (40.4%) had elevated REM-C, (≥0.9 mmol/L). 13.8% had both elevated Lp(a) and LDL-C, 16.0% had both elevated LDL-C and REM-C, and 3.2% had both elevated Lp(a) and REM-C. Eight (8) patients (8.5%) had elevated Lp(a), LDL-C and REM-C. Overall, only 9.6% of the cohort had optimal levels for LDL-C, triglycerides, HDL-C [
        • Mach F.
        • Baigent C.
        • Catapano A.L.
        • Koskinas K.C.
        • Casula M.
        • Badimon L.
        • et al.
        2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk.
        ], Lp(a) [
        • Patel A.P.
        • Wang M.
        • Pirruccello J.P.
        • Ellinor P.T.
        • Ng K.
        • Kathiresan S.
        • et al.
        Lp(a) (Lipoprotein[a]) Concentrations and incident atherosclerotic cardiovascular disease: new insights from a large national biobank.
        ,
        • Willeit P.
        • Ridker P.M.
        • Nestel P.J.
        • Simes J.
        • Tonkin A.M.
        • Pedersen T.R.
        • et al.
        Baseline and on-statin treatment lipoprotein(a) levels for prediction of cardiovascular events: individual patient-data meta-analysis of statin outcome trials.
        ] and REM-C [
        • Quispe R.
        • Martin S.S.
        • Michos E.D.
        • Lamba I.
        • Blumenthal R.S.
        • Saeed A.
        • et al.
        Remnant cholesterol predicts cardiovascular disease beyond LDL and ApoB: a primary prevention study.
        ,
        • Varbo A.
        • Freiberg J.J.
        • Nordestgaard B.G.
        Extreme nonfasting remnant cholesterol vs extreme LDL cholesterol as contributors to cardiovascular disease and all-cause mortality in 90000 individuals from the general population.
        ].
      Figure thumbnail gr1
      Figure 1Lipid-related residual risk in statin-treated patients presenting to the Coronary Care Unit with ACS.
      Abbreviations: REM-C, remnant cholesterol; LDL-C, low-density lipoprotein cholesterol.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart, Lung and Circulation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Langsted A.
        • Madsen C.M.
        • Nordestgaard B.G.
        Contribution of remnant cholesterol to cardiovascular risk.
        J Intern Med. 2020; 288: 116-127
        • Mach F.
        • Baigent C.
        • Catapano A.L.
        • Koskinas K.C.
        • Casula M.
        • Badimon L.
        • et al.
        2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk.
        Eur Heart J. 2020; 41: 111-188
        • Patel A.P.
        • Wang M.
        • Pirruccello J.P.
        • Ellinor P.T.
        • Ng K.
        • Kathiresan S.
        • et al.
        Lp(a) (Lipoprotein[a]) Concentrations and incident atherosclerotic cardiovascular disease: new insights from a large national biobank.
        Arterioscler Thromb Vasc Biol. 2021; 41: 465-474
        • Willeit P.
        • Ridker P.M.
        • Nestel P.J.
        • Simes J.
        • Tonkin A.M.
        • Pedersen T.R.
        • et al.
        Baseline and on-statin treatment lipoprotein(a) levels for prediction of cardiovascular events: individual patient-data meta-analysis of statin outcome trials.
        Lancet. 2018; 392: 1311-1320
        • Quispe R.
        • Martin S.S.
        • Michos E.D.
        • Lamba I.
        • Blumenthal R.S.
        • Saeed A.
        • et al.
        Remnant cholesterol predicts cardiovascular disease beyond LDL and ApoB: a primary prevention study.
        Eur Heart J. 2021; 42: 4324-4332
        • Varbo A.
        • Freiberg J.J.
        • Nordestgaard B.G.
        Extreme nonfasting remnant cholesterol vs extreme LDL cholesterol as contributors to cardiovascular disease and all-cause mortality in 90000 individuals from the general population.
        Clin Chem. 2015; 61: 533-543