残余胆固醇作为接受他汀类降脂治疗的动脉粥样硬化性心血管疾病患者的残余风险：RACING试验的事后分析

Remnant cholesterol as a residual risk in atherosclerotic cardiovascular disease patients under statin-based lipid-lowering therapy: A post hoc analysis of the RACING trial.

作者信息

Lee Jung-Hee, Ahn Sung Gyun, Jeon Ho Sung, Lee Jun-Won, Youn Young Jin, Lee Yong-Joon, Lee Seung-Jun, Hong Sung-Jin, Ahn Chul-Min, Ko Young-Guk, Kim Jung-Sun, Choi Donghoon, Hong Myeong-Ki, Jang Yangsoo, Kim Byeong-Keuk

机构信息

Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea (Drs Lee, Ahn, Jeon, Lee, and Youn).

出版信息

J Clin Lipidol. 2024 Nov-Dec;18(6):e905-e914. doi: 10.1016/j.jacl.2024.07.005. Epub 2024 Jul 27.

DOI:10.1016/j.jacl.2024.07.005

PMID:39322526

Abstract

BACKGROUND

Remnant cholesterol (remnant-C) levels during lipid-lowering therapy (LLT) may indicate residual risk.

OBJECTIVE

We aimed to investigate the clinical outcomes based on on-treatment remnant-C distribution in patients with atherosclerotic cardiovascular disease (ASCVD) under statin-based LLT.

METHODS

In this post hoc analysis of the RACING trial, 3,348 patients with ASCVD lipid profiles 1 year after randomization were investigated. Remnant-C was calculated as total cholesterol minus low-density lipoprotein cholesterol (LDL-C) minus high-density lipoprotein cholesterol. The primary endpoint was a 3-year composite of cardiovascular death, major cardiovascular events, or non-fatal stroke.

RESULTS

The study population was grouped into tertiles according to on-treatment remnant-C: high (> 20.5 mg/dL; n = 1,116), intermediate (14‒20.5 mg/dL; n = 1,031), and low (≤14.0 mg/dL; n = 1,201) remnant-C groups. The high remnant-C group showed the highest incidence of the primary endpoint at 3 years (11.0%, 10.3%, and 7.5% in the high, intermediate, and low remnant-C groups, respectively; p = 0.009). The high remnant-C levels at 1 year were independently associated with an increased risk of the primary outcome, whereas achieving LDL-C < 55 or 70 mg/dL was not associated with the incidence of the primary endpoint. The on-treatment remnant-C cut-off of 17 mg/dL (median) demonstrated the ability to discriminate between patients at higher and lower risks for the primary endpoints (hazard ratio: 1.42; 95% confidence interval: 1.14‒1.78; p = 0.002).

CONCLUSIONS

In patients with ASCVD undergoing statin-based LLT, high on-treatment remnant-C values were associated with unfavorable clinical outcomes. On-treatment remnant-C levels may serve as an additional means of assessing residual cardiovascular risk.

CLINICAL TRIAL REGISTRATION

ClinicalTrials. gov ID: NCT03044665.

摘要

背景

降脂治疗（LLT）期间的残余胆固醇（remnant-C）水平可能提示残余风险。

目的

我们旨在研究基于他汀类LLT的动脉粥样硬化性心血管疾病（ASCVD）患者治疗期间残余-C分布的临床结局。

方法

在这项RACING试验的事后分析中，对随机分组1年后的3348例ASCVD血脂谱患者进行了研究。残余-C的计算方法为总胆固醇减去低密度脂蛋白胆固醇（LDL-C）减去高密度脂蛋白胆固醇。主要终点是心血管死亡、主要心血管事件或非致命性卒中的3年复合终点。

结果

根据治疗期间残余-C将研究人群分为三分位数：高残余-C组（>20.5mg/dL；n=1116）、中残余-C组（14-20.5mg/dL；n=1031）和低残余-C组（≤14.0mg/dL；n=1201）。高残余-C组在3年时主要终点的发生率最高（高、中、低残余-C组分别为11.0%、10.3%和7.5%；p=0.009）。1年时的高残余-C水平与主要结局风险增加独立相关，而LDL-C<55或70mg/dL与主要终点的发生率无关。治疗期间残余-C的截断值为17mg/dL（中位数）显示出区分主要终点高风险和低风险患者的能力（风险比：1.42；95%置信区间：1.14-1.78；p=0.002）。