Factors predicting cardiovascular events in statin-treated diabetic and non-diabetic patients with coronary atherosclerosis

ObjectiveWe aimed at identifying which lipid factors drive vascular risk in statin-treated patients with coronary artery disease (CAD).MethodsWe recorded vascular events over 5.6 years in 491 consecutive statin-treated patients with angiographically proven stable CAD, covering 2750 patient-years.ResultsIn the total population, low high-density lipoprotein (HDL) cholesterol (standardized adjusted HR 0.73 [0.60-0.89]; p = 0.001), low apolipoprotein A1 (0.77 [0.65-0.92]; p = 0.003), a small low-density lipoprotein (LDL) particle diameter (0.76 [0.64-0.91]; p = 0.002), and high triglycerides (1.20 [1.05-1.38]; p = 0.007) predicted vascular events, but not total cholesterol, LDL cholesterol, or apolipoprotein B. Factor analysis in the lipid profiles of our patients revealed an HDL-related factor and an LDL-related factor. Concordant with the results for individual lipid parameters, the HDL-related factor (0.69 [0.58-0.83]; p < 0.001) but not the LDL-related factor (p = 0.455) predicted vascular events. Patients with type 2 diabetes (T2DM; n = 116) were at a higher vascular risk than non-diabetic subjects (38.6% vs. 24.1%; p < 0.001), and like in the total population the HDL-related factor (0.59 [0.44-0.77]; p < 0.001) but not the LDL-related factor (p = 0.591) predicted vascular risk in diabetic patients.ConclusionsThe pattern of low HDL cholesterol, low apolipoprotein A1, small LDL particles, and high triglycerides drives vascular risk in statin-treated coronary patients, particularly in those with T2DM.