Relative value of plasma nitrotyrosine for predicting mortality in patients with coronary artery diseases

Background: Reactive oxygen species (ROS) mediate the signalling of chief inflammatory pathways throughout all stages of atherosclerosis from endothelial dysfunction to plaque rupture. Activated leukocytes within the atherosclerotic lesion produce ROS, causing local and systemic oxidative injury; however, contributions of ROS production to the clinical features atherosclerosis have not yet been clearly established. Markers of oxidative stress include nitrotyrosine (N-tyr), a post-translational modification generated by reactive nitrogen species. N-tyr is enriched in atherosclerotic lesions, where it activates interstitial metalloproteases, which destabilize the lesion and induce plaque rupture. Recent findings associate circulating N-tyr levels with CAD pathogenesis: N-tyr levels are elevated in patients with established CAD, increased by risk factors associated with atherosclerosis, and reduced by statin therapy. The value circulating N-tyr may have for predicting outcome in CAD patients has not yet been determined. Study Design: We tested the hypothesis that elevated N-tyr predicts mortality in patients with coronary artery disease. Plasma levels of N-tyr were measured using an enzyme-linked immunoassay (Hycult) in a cohort of 619 patients with angiographic evidence of coronary artery disease. After a mean follow-up time of 8.5 years, cases of all-cause mortality (145 cases) and cardiovascular mortality (76 cases) were collected using BC Vital Statistics Agency. The relative value of plasma N-tyr for prediction of mortality was determined using Cox proportional hazards model with adjustment for the following covariates: age, sex, smoking status, hypertension, BMI, LDL-cholesterol, total:HDL-cholesterol, plasma c-reactive protein, personal or known family history of CAD, and reported use of lipid-lowering or antioxidant therapies. Interpretation: Patients whose plasma N-tyr levels were above the cohort median (71.75 nmol/L) had an increased risk of mortality, however this increased risk did not reach conventional statistical significance after covariate adjustment [HR(CI):1.39(0.96-2.01) p=0.07]. No significant association was observed between N-tyr levels and risk of cardiovascular mortality. While this investigation did not reveal a strong association between elevated N-tyr levels and cardiovascular mortality, the trend for increased risk of all-cause mortality indicates that this marker of oxidative stress could be used to identify patients for whom oxidative processes contribute significantly to disease pathogenesis. Further studies are warranted to establish the clinical value of N-tyr and other oxidative stress biomarkers, with the ultimate goal of improving patient risk assessment, and monitoring primary and secondary cardiovascular risk-reduction strategies.

Download Full-text

Abstract 18995: Statins in Familial Hypercholesterolemia - Effects on Coronary Artery Disease and All-cause Mortality

Circulation ◽

10.1161/circ.132.suppl_3.18995 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Joost Besseling ◽

Gerard K Hovingh ◽

John J Kastelein ◽

Barbara A Hutten

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Familial Hypercholesterolemia ◽

Lipid Lowering ◽

Premature Coronary Artery Disease ◽

Lipid Lowering Therapy ◽

Time Varying ◽

All Cause Mortality ◽

Artery Disease

Introduction: Heterozygous familial hypercholesterolemia (heFH) is characterized by high levels of low-density lipoprotein cholesterol (LDL-C) and increased risk for premature coronary artery disease (CAD) and death. Reduction of CAD and mortality by statins has not been properly quantified in heFH. The aim of the current study is to determine the effect of statins on CAD and mortality in heFH. Methods: All adult heFH patients identified by the Dutch FH screening program between 1994 and 2014 and registered in the PHARMO Database Network were eligible. Of these patients we obtained hospital, pharmacy (in- and outpatient), and mortality records in the period between 1995 and 2015. The effect of statins (time-varying) on CAD and all-cause mortality was determined using a Cox proportional hazard model, while correcting for the use of other lipid-lowering therapy, thrombocyte aggregation inhibitors, antihypertensive and antidiabetic medication (all time-varying). Furthermore, we used inverse probability for treatment weighting (IPTW) to account for differences between statin-treated and untreated patients regarding history of CAD before follow-up, age at start of follow-up and age of screening, as well as body mass index, LDL-C and triglycerides. Results: Of the 25,479 identified heFH patients, 11,021 gave informed consent to obtain their medical records, of whom 2,447 could be retrieved. We excluded 766 patients younger than 18. The remaining 1,681 heFH patients comprised our study population and these had very similar characteristics as compared to the 23,798 excluded FH patients, e.g. mean (SD) LDL-C levels were 214 (74) vs. 203 (77) mg/dL. Among 1,151 statin users, there were 133 CAD events and 15 deaths during 10,115 statin treated person-years, compared to 17 CAD events and 9 deaths during 4,965 person-years in 530 never statin users (combined rate: 14.6 vs. 5.2, respectively, p<0.001). After applying IPTW to account for indication bias and correcting for use of other medications, the hazard ratio of statin use for CAD and all-cause mortality was 0.61 (0.40 - 0.93). Conclusions: In heFH patients, statins lower the risk for CAD and mortality by 39%.

Download Full-text

Association of Longitudinal Change in High-Sensitivity Troponin with All-Cause Mortality in Coronary Artery Disease: The Heart and Soul Study

Cardiology ◽

10.1159/000503954 ◽

2020 ◽

Vol 145 (2) ◽

pp. 63-70

Author(s):

Yaanik B. Desai ◽

Rakesh K. Mishra ◽

Qizhi Fang ◽

Mary A. Whooley ◽

Nelson B. Schiller

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

High Sensitivity ◽

Community Dwelling ◽

Longitudinal Change ◽

Clinical Variables ◽

Risk Of Death ◽

Increased Risk ◽

All Cause Mortality ◽

Artery Disease

Background: Serial increases in high-sensitivity cardiac troponin (hs-cTnT) have been associated with death in community-dwelling adults, but the association remains uninvestigated in those with coronary artery disease (CAD). Methods: We measured hs-cTnT at baseline and after 5 years in 635 ambulatory Heart and Soul Study patients with CAD. We also performed echocardiography at rest and after treadmill exercise at baseline and after 5 years. Participants were subsequently followed for the outcome of death. We used a multivariable-adjusted Cox proportional hazards model to evaluate the association between 5-year change in hs-cTnT and subsequent all-cause mortality. Results: Of the 635 subjects, there were 386 participants (61%) who had an increase in hs-cTnT levels between baseline and year 5 measurements (median increase 5.6 pg/mL, IQR 3.2–9.9 pg/mL). There were 182 deaths after a mean 4.2-year follow-up after the year 5 visit. After adjusting for clinical variables, a >50% increase in hs-cTnT between baseline and year 5 was associated with a nearly 2-fold increased risk of death from any cause (hazard ratio 1.7, 95% confidence interval 1.1–2.7). When addition of year 5 hs-cTnT was compared to a model including clinical variables and baseline hs-cTnT, there was a modest but statistically significant increase in C-statistic from 0.82 to 0.83 (p = 0.04). Conclusion: In ambulatory patients with CAD, serial increases in hs-cTnT over time are associated with an increased risk of death.

Download Full-text

Association between Serum Interleukin-6 Concentration and Mortality in Patients with Coronary Artery Disease

Mediators of Inflammation ◽

10.1155/2013/726178 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 32

Author(s):

Dongfang Su ◽

Zhongxia Li ◽

Xinrui Li ◽

Yuming Chen ◽

Yuan Zhang ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Cardiovascular Mortality ◽

Interleukin 6 ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Hazard Ratios ◽

Risk Of Mortality ◽

Increased Risk ◽

Artery Disease

Objectives. To evaluate whether serum interleukin-6 (IL-6) is associated with increased risk of mortality in coronary artery disease (CAD) patients.Methods. We performed a prospective cohort study of 718 CAD patients from the Guangzhou Cardiovascular Disease Cohort (GCDC) study. Multivariable-adjusted Cox proportional hazards regression analyses were used to examine the association between serum IL-6 with all-cause and cardiovascular mortality.Results. During the 1663 person-years of followup, the cumulative all-cause mortality and cardiovascular mortality were 6.5% (n=47) and 3.3% (n=24), respectively. The mean length of followup was2.32±0.81years. In the multivariable analyses, a one-SD increment in log-transformed serum IL-6 was positively associated with an increased risk of all-cause and cardiovascular mortality, with hazard ratios (HR) of 2.93 (95% CI, 2.11–4.08) and 2.04 (95% CI, 1.34–3.68) within the patients combined and 2.98 (95% CI, 2.12–4.18) and 3.10 (95% CI, 1.98–4.85) within males, respectively. Patients in the highest serum IL-6 tertile versus the lowest tertile were at higher risk of all-cause and cardiovascular mortality, with HR of 17.12 (95% CI 3.11–71.76) and 8.68 (95% CI, 1.88–37.51), respectively.Conclusions. In hospitalized patients with CAD, serum IL-6 is significantly associated with all-cause and cardiovascular mortality.

Download Full-text

Lower Plasma Fetuin-A Levels Are Associated With a Higher Mortality Risk in Patients With Coronary Artery Disease

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvbaha.117.309700 ◽

2017 ◽

Vol 37 (11) ◽

pp. 2213-2219 ◽

Cited By ~ 9

Author(s):

Xuechen Chen ◽

Yuan Zhang ◽

Qian Chen ◽

Qing Li ◽

Yanping Li ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Confidence Interval ◽

Enzyme Linked Immunosorbent Assay ◽

Lower Plasma ◽

Fetuin A ◽

Increased Risk ◽

All Cause Mortality ◽

Artery Disease ◽

Cvd Mortality

Objective— The present study was designed to evaluate the association of circulating fetuin-A with cardiovascular disease (CVD) and all-cause mortality. Approach and Results— We measured plasma fetuin-A in 1620 patients using an enzyme-linked immunosorbent assay kit. The patients were members of the Guangdong coronary artery disease cohort and were recruited between October 2008 and December 2011. Cox regression models were used to estimate the association between plasma fetuin-A and the risk of mortality. A total of 206 deaths were recorded during a median follow-up of 5.9 years, 146 of whom died from CVD. The hazard ratios for the second and third tertiles of the fetuin-A levels (using the first tertile as a reference) were 0.65 (95% confidence interval, 0.44–0.96) and 0.51 (95% confidence interval, 0.33–0.78) for CVD mortality ( P =0.005) and 0.65 (95% confidence interval, 0.47–0.91) and 0.48 (95% confidence interval, 0.33–0.70) for all-cause mortality ( P <0.001), respectively. Conclusions— Lower plasma fetuin-A levels were associated with an increased risk of all-cause and CVD mortality in patients with coronary artery disease independently of traditional CVD risk factors.

Download Full-text

Outcomes in the ISCHEMIA Trial Based on Coronary Artery Disease and Ischemia Severity

Circulation ◽

10.1161/circulationaha.120.049755 ◽

2021 ◽

Vol 144 (13) ◽

pp. 1024-1038 ◽

Cited By ~ 3

Author(s):

Harmony R. Reynolds ◽

Leslee J. Shaw ◽

James K. Min ◽

Courtney B. Page ◽

Daniel S. Berman ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Management Strategy ◽

Prognostic Index ◽

Cardiovascular Death ◽

End Point ◽

Increased Risk ◽

All Cause Mortality ◽

Artery Disease ◽

Severe Ischemia

Background: The ISCHEMIA trial (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) postulated that patients with stable coronary artery disease (CAD) and moderate or severe ischemia would benefit from revascularization. We investigated the relationship between severity of CAD and ischemia and trial outcomes, overall and by management strategy. Methods: In total, 5179 patients with moderate or severe ischemia were randomized to an initial invasive or conservative management strategy. Blinded, core laboratory–interpreted coronary computed tomographic angiography was used to assess anatomic eligibility for randomization. Extent and severity of CAD were classified with the modified Duke Prognostic Index (n=2475, 48%). Ischemia severity was interpreted by independent core laboratories (nuclear, echocardiography, magnetic resonance imaging, exercise tolerance testing, n=5105, 99%). We compared 4-year event rates across subgroups defined by severity of ischemia and CAD. The primary end point for this analysis was all-cause mortality. Secondary end points were myocardial infarction (MI), cardiovascular death or MI, and the trial primary end point (cardiovascular death, MI, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest). Results: Relative to mild/no ischemia, neither moderate ischemia nor severe ischemia was associated with increased mortality (moderate ischemia hazard ratio [HR], 0.89 [95% CI, 0.61–1.30]; severe ischemia HR, 0.83 [95% CI, 0.57–1.21]; P =0.33). Nonfatal MI rates increased with worsening ischemia severity (HR for moderate ischemia, 1.20 [95% CI, 0.86–1.69] versus mild/no ischemia; HR for severe ischemia, 1.37 [95% CI, 0.98–1.91]; P =0.04 for trend, P =NS after adjustment for CAD). Increasing CAD severity was associated with death (HR, 2.72 [95% CI, 1.06–6.98]) and MI (HR, 3.78 [95% CI, 1.63–8.78]) for the most versus least severe CAD subgroup. Ischemia severity did not identify a subgroup with treatment benefit on mortality, MI, the trial primary end point, or cardiovascular death or MI. In the most severe CAD subgroup (n=659), the 4-year rate of cardiovascular death or MI was lower in the invasive strategy group (difference, 6.3% [95% CI, 0.2%–12.4%]), but 4-year all-cause mortality was similar. Conclusions: Ischemia severity was not associated with increased risk after adjustment for CAD severity. More severe CAD was associated with increased risk. Invasive management did not lower all-cause mortality at 4 years in any ischemia or CAD subgroup. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01471522.

Download Full-text

Abstract 3526: Medication Non-adherence Is Associated With A Broad Range Of Adverse Outcomes In Patients With Coronary Artery Disease

Circulation ◽

10.1161/circ.116.suppl_16.ii_798-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

P. Michael Ho ◽

David J Magid ◽

Susan M Shetterly ◽

Kari L Olson ◽

Thomas M Maddox ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Cardiovascular Mortality ◽

Ace Inhibitors ◽

Adverse Outcomes ◽

Care Organization ◽

Increased Risk ◽

Β Blockers ◽

Artery Disease ◽

Revascularization Procedures

Background: Little is known about the effect of non-adherence among coronary artery disease (CAD) patients on a broad spectrum of outcomes including cardiovascular mortality, cardiovascular hospitalizations or revascularization procedures. Methods: This was a retrospective cohort study of 15,767 patients with CAD in a managed care organization. Medication adherence was calculated as proportion of days covered (PDC) for filled prescriptions of β-blockers, ACE-inhibitors, and statin medications. Multivariable Cox regression assessed the association between medication non-adherence as a time-varying covariate and mortality (all-cause and cardiovascular), adjusting for demographics and clinical characteristics. Median follow-up was 4.1 years. Results: Across the three classes of medications, non-adherent patients were more likely to be younger and have a diagnosis of COPD or depression. In unadjusted analysis, non-adherence to each individual class of medication was associated with higher all-cause and cardiovascular mortality. In multivariable analysis, non-adherence remained significantly associated with increased all-cause mortality risk for β-blockers (HR 1.50; 95% CI 1.33–1.71), ACE-inhibitors (HR 1.74; 95% CI 1.52–1.98), and statins (HR 1.85; 95% CI 1.63–2.09). In addition, non-adherence remained significantly associated with higher risk of cardiovascular mortality for β-blockers (HR 1.53; 95% CI 1.16 –2.01), ACE-inhibitors (HR 1.66; 95% CI 1.26 –2.20), and statins (HR 1.62; 95% CI 1.124 –2.13). The findings of increased risk associated with non-adherence were consistent for cardiovascular hospitalization and revascularization procedures. Conclusions: Non-adherence to cardioprotective medications is associated with a broad range of adverse outcomes. These findings support the importance of non-adherence in clinical practice and suggest that medication non-adherence should be a target for future interventions.

Download Full-text

Asymmetrical Dimethylarginine Independently Predicts Total and Cardiovascular Mortality in Individuals with Angiographic Coronary Artery Disease (The Ludwigshafen Risk and Cardiovascular Health Study)

Clinical Chemistry ◽

10.1373/clinchem.2006.076711 ◽

2007 ◽

Vol 53 (2) ◽

pp. 273-283 ◽

Cited By ~ 160

Author(s):

Andreas Meinitzer ◽

Ursula Seelhorst ◽

Britta Wellnitz ◽

Gabriele Halwachs-Baumann ◽

Bernhard O Boehm ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Cardiovascular Risk ◽

Coronary Artery ◽

Cardiovascular Risk Factors ◽

Cardiovascular Mortality ◽

Asymmetrical Dimethylarginine ◽

Hazard Ratios ◽

Increased Risk ◽

Artery Disease

Abstract Background: Asymmetrical dimethylarginine (ADMA) is increased in conditions associated with increased risk of atherosclerosis. We investigated the use of ADMA to predict total and cardiovascular mortality in patients scheduled for coronary angiography. Methods: In 2543 persons with and 695 without coronary artery disease (CAD) identified by angiography we measured ADMA and recorded total and cardiovascular mortality during a median follow-up of 5.45 years. Results: ADMA was correlated positively to age, female sex, diabetes mellitus, former and current smoking, and C-reactive protein and inversely to HDL cholesterol and triglycerides. ADMA was not associated with body mass index, hypertension, LDL cholesterol, or the presence or absence of angiographic CAD. Glomerular filtration rate and homocysteine were the strongest predictors of ADMA. At the 2nd, 3rd and 4th quartile of ADMA, hazard ratios for all-cause mortality adjusted for age, sex, and cardiovascular risk factors were 1.12 [95% confidence interval (CI) 0.83–1.52], 1.35 (95% CI 1.01–1.81), and 1.87 (95% CI 1.43–2.44), respectively, compared with the 1st quartile. Hazard ratios for cardiovascular death were 1.13 (95% CI 0.78–1.63), 1.42 (95% CI 1.00–2.02), and 1.81 (95% CI 1.31–2.51). ADMA in the highest quartile remained predictive of mortality after accounting for medication at baseline. The predictive value of ADMA was similar to that in the entire cohort in persons with CAD, stable or unstable, but was not statistically significant in persons without angiographic CAD. Conclusions: ADMA concentration predicts all-cause and cardiovascular mortality in individuals with CAD independently of established and emerging cardiovascular risk factors.

Download Full-text

Independent and Combined Effects of Telomere Shortening and mtDNA4977 Deletion on Long-term Outcomes of Patients with Coronary Artery Disease

International Journal of Molecular Sciences ◽

10.3390/ijms20215508 ◽

2019 ◽

Vol 20 (21) ◽

pp. 5508 ◽

Cited By ~ 2

Author(s):

Cecilia Vecoli ◽

Andrea Borghini ◽

Silvia Pulignani ◽

Antonella Mercuri ◽

Stefano Turchi ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Reference Model ◽

Disease Risk ◽

Major Adverse Cardiovascular Events ◽

Net Reclassification Improvement ◽

Increased Risk ◽

All Cause Mortality ◽

Artery Disease

Aging is one of the main risk factors for cardiovascular disease, resulting in a progressive organ and cell decline. This study evaluated a possible joint impact of two emerging hallmarks of aging, leucocyte telomere length (LTL) and common mitochondrial DNA deletion (mtDNA4977), on major adverse cardiovascular events (MACEs) and all-cause mortality in patients with coronary artery disease (CAD). We studied 770 patients (673 males, 64.8 ± 8.3 years) with known or suspected stable CAD. LTL and mtDNA4977 deletion were assessed in peripheral blood using qRT-PCR. During a median follow-up of 5.4 ± 1.2 years, MACEs were 140 while 86 deaths were recorded. After adjustments for confounding risk factors, short LTLs and high mtDNA4977 deletion levels acted independently as predictors of MACEs (HR: 2.2, 95% CI: 1.2–3.9, p = 0.01 and HR: 1.7, 95% CI: 1.1–2.9, p = 0.04; respectively) and all-cause mortality events (HR: 2.1, 95% CI: 1.1–4.6, p = 0.04 and HR: 2.3, 95% CI: 1.1–4.9, p = 0.02; respectively). Patients with both short LTLs and high mtDNA4977 deletion levels had an increased risk for MACEs (HR: 4.3; 95% CI: 1.9–9.6; p = 0.0006) and all-cause mortality (HR: 6.0; 95% CI: 2.0–18.4; p = 0.001). The addition of mtDNA4977 deletion to a clinical reference model was associated with a significant net reclassification improvement (NRI = 0.18, p = 0.01). Short LTL and high mtDNA4977 deletion showed independent and joint predictive value on adverse cardiovascular outcomes and all-cause mortality in patients with CAD. These findings strongly support the importance of evaluating biomarkers of physiological/biological age, which can predict disease risk and mortality more accurately than chronological age.

Download Full-text

Impact of left ventricular function on clinical outcomes among patients with coronary artery disease

European Journal of Preventive Cardiology ◽

10.1177/2047487319841939 ◽

2019 ◽

Vol 26 (12) ◽

pp. 1273-1284 ◽

Cited By ~ 4

Author(s):

George CM Siontis ◽

Mattia Branca ◽

Patrick Serruys ◽

Sigmund Silber ◽

Lorenz Räber ◽

...

Keyword(s):

Coronary Artery Disease ◽

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Cardiac Death ◽

Coronary Intervention ◽

Increased Risk ◽

Percutaneous Coronary ◽

All Cause Mortality ◽

Artery Disease

Aims To investigate the clinical relevance of contemporary cut-offs of left ventricular ejection fraction (LVEF) including an intermediate phenotype with mid-range reduced ejection fraction among patients with coronary artery disease undergoing percutaneous coronary intervention. Methods and results Patient-level data were summarized from five randomized clinical trials in which 6198 patients underwent clinically indicated percutaneous coronary intervention in different clinical settings. We assessed all-cause mortality as primary endpoint at five-year follow-up. According to the proposed LVEF cut-offs, 3816 patients were included in the preserved LVEF group (LVEF ≥ 50%), 1793 in the mid-range reduced LVEF group (LVEF 40–49%) and 589 patients in the reduced LVEF group (LVEF < 40%). Patients in the reduced LVEF group were at increased risk for the primary outcome of all-cause mortality compared with both, preserved and mid-range LVEF throughout five years of follow-up (adjusted hazard ratio 2.39 (95% confidence interval 1.75–3.28, p < 0.001) and 1.68 (95% confidence interval 1.34–2.10, p < 0.001), respectively). The risk of cardiac death and the composite endpoint of cardiac death, myocardial infarction, or stroke were higher for patients in the reduced LVEF group compared with the preserved and mid-range reduced LVEF groups, but also for the mid-range LVEF compared with preserved LVEF group (adjusted p < 0.05 for all comparisons) throughout five years. Irrespective of clinical presentation at baseline (stable coronary artery disease or acute coronary syndrome), patients with reduced or mid-range LVEF were at increased risk of all-cause mortality and cardiac death up to five years compared with the other group (adjusted p < 0.05 for all comparisons). Conclusion Patients with reduced LVEF <40% or mid-range LVEF 40–49% in the context of coronary artery disease undergoing clinically indicated percutaneous coronary intervention are at increased risk of all-cause mortality, cardiac death and the composite of cardiac death, stroke and myocardial infarction throughout five years of follow-up. The recently proposed LVEF cut-offs contribute to the differentiation and risk stratification of patients with ischaemic heart disease.

Download Full-text

Triglyceride to high-density lipoprotein cholesterol ratio predicts all-cause and cardiovascular mortality in diabetic patients with coronary artery disease on statin treatment

10.21203/rs.3.rs-190993/v1 ◽

2021 ◽

Author(s):

Le Wang ◽

Hongliang Cong ◽

JingXia Zhang ◽

YueCheng Hu ◽

Ao Wei ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Cardiovascular Mortality ◽

Density Lipoprotein ◽

Statin Treatment ◽

Diabetic Patients ◽

C Statistic ◽

All Cause Mortality ◽

Patients With Diabetes ◽

Artery Disease

Abstract Background The triglyceride (TG)to high-density lipoprotein cholesterol (HDL-C) ratio has been regarded as an independent predictor of cardiovascular events. However, the association of TG/HDL-C ratio with survival in patients with diabetes and coronary artery disease (CAD) on statin therapy remains uncertain. The aim of the present study was to explore whether TG/HDL-C ratio predicts mortality in diabetic patients with CAD on statin treatment. Methods A total of 2080 consecutive patients with type 2 diabetes and angiographic-proven CAD who were treated with statin were enrolled in the presents study. Patients were divided into tertiles according to baseline TG/HDL-C ratio. The primary endpoints were all-cause and cardiovascular mortality. Results During 4-year follow-up, 209(10.0%) patients died, 136(65.1%) caused by cardiovascular disease (CVD). The Kaplan-Meier analyses showed that all-cause and cardiovascular mortality increased gradually with rising TG/HDL-C ratio tertiles (log-rank test, P < 0.001, respectively). Multivariate cox hazard regression analysis revealed that patients in tertile 3 but not teretile 2 had significantly higher rate of all-cause and cardiovascular mortality (P < 0.001, P < 0.05, respectively). Moreover, TG/HDL-C ratio was independently associated with all-cause mortality (HR: 1.21, 95% CI:1.11–1.31; P < 0.001) and cardiovascular mortality (HR:1.28, 95% CI: 1.19–1.37; P < 0.001). For all-cause mortality, TG/HDL-C ratio significantly improved the C-statistic (0.799[0.766–0.833] to 0.813[0.780–0.845]; P = 0.018), net reclassification index (NRI) (0.315; P < 0.001), and integrated discrimination index (IDI) (0.012; P = 0.003). For cardiovascular mortality, TG/HDL-C ratio significantly improved the C-statistic (0.769[0.727–0.812] to 0.810[0.771–0.849]; P = 0.001), NRI (0.442; P < 0.001), and IDI (0.039; P < 0.001). Conclusions TG/HDL-C ratio may predict mortality risk among diabetic CAD patients receiving statin treatment. These findings suggest that assessing TG/HDL-C ratio may be useful for risk stratification for mortality risk in patients with diabetes and CAD.

Download Full-text