High-Density Lipoprotein Cholesterol and Cardiovascular Events in Patients with Stable Coronary Artery Disease Treated with Statins: An Observation from the REAL-CAD Study
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- Omote Kazunori
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
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- Yokota Isao
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University
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- Nagai Toshiyuki
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
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- Sakuma Ichiro
- Caress Sapporo Hokko Memorial Clinic
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- Nakagawa Yoshihisa
- Department of Cardiovascular Medicine, Shiga University of Medical Science Hospital
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- Kamiya Kiwamu
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
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- Iwata Hiroshi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
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- Miyauchi Katsumi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
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- Ozaki Yukio
- Department of Cardiology, Fujita Health University School of Medicine
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- Hibi Kiyoshi
- Division of Cardiology, Yokohama City University Medical Center
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- Hiro Takafumi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
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- Fukumoto Yoshihiro
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
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- Mori Hiroyoshi
- Department of Cardiology, Showa University Fujigaoka Hospital
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- Hokimoto Seiji
- Department of Cardiovascular Medicine, Kumamoto University Hospital
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- Ohashi Yasuo
- Department of Integrated Science and Technology for Sustainable Society, Chuo University
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- Ohtsu Hiroshi
- National Center for Global Health and Medicine, Center for Clinical Sciences
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- Ogawa Hisao
- National Cerebral and Cardiovascular Center
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- Daida Hiroyuki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
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- Iimuro Satoshi
- Teikyo Academic Research Center, Teikyo University
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- Shimokawa Hiroaki
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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- Saito Yasushi
- Chiba University
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- Kimura Takeshi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
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- Matsuzaki Masunori
- St. Hill Hospital
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- Nagai Ryozo
- Jichi Medical University
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- Anzai Toshihisa
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
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<p>Aim: The association between high-density lipoprotein cholesterol (HDL-C) level after statin therapy and cardiovascular events in patients with stable coronary artery disease (CAD) remains unclear. Thus, in this study, we sought to determine how HDL-C level after statin therapy is associated with cardiovascular events in stable CAD patients. </p><p>Methods: From the REAL-CAD study which had shown the favorable prognostic effect of high-dose pitavastatin in stable CAD patients with low-density lipoprotein cholesterol (LDL-C) ＜120 mg/dL, 9,221 patients with HDL-C data at baseline and 6 months, no occurrence of primary outcome at 6 months, and reported non-adherence for pitavastatin, were examined. The primary outcome was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal ischemic stroke, or unstable angina requiring emergent admission after 6 months of randomization. Absolute difference and ratio of HDL-C levels were defined as (those at 6 months–at baseline) and (absolute difference/baseline)×100, respectively. </p><p>Results: During a median follow-up period of 4.0 (IQR 3.2–4.7) years, the primary outcome occurred in 417 (4.5%) patients. The adjusted risk of all HDL-C-related variables (baseline value, 6-month value, absolute, and relative changes) for the primary outcome was not significant (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.91–1.08, HR 1.03, 95% CI 0.94–1.12, HR 1.05, 95% CI 0.98–1.12, and HR 1.08, 95% CI 0.94–1.24, respectively). Furthermore, adjusted HRs of all HDL-C-related variables remained non-significant for the primary outcome regardless of on-treatment LDL-C level at 6 months. </p><p>Conclusions: After statin therapy with modestly controlled LDL-C, HDL-C level has little prognostic value in patients with stable CAD. </p>
収録刊行物
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- Ｊｏｕｒｎａｌ ｏｆ Ａｔｈｅｒｏｓｃｌｅｒｏｓｉｓ ａｎｄ Ｔｈｒｏｍｂｏｓｉｓ
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Ｊｏｕｒｎａｌ ｏｆ Ａｔｈｅｒｏｓｃｌｅｒｏｓｉｓ ａｎｄ Ｔｈｒｏｍｂｏｓｉｓ 29 (1), 50-68, 2022-01-01
一般社団法人 日本動脈硬化学会