Background: Cardiovascular (CV) event risk is significantly lower in patients with combined low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) at desired levels versus those without lower levels. However, this has not been investigated relative to specific patterns of baseline lipid abnormalities.
Objective: To evaluate the association between desired combined lipid value achievement and risk of CV events in patients with different baseline lipid profiles.
Methods: A retrospective managed care database analysis among treatment-naïve adults with elevated CV event risk, ≥12 months follow-up, and full lipid panel from January 1, 2001 to December 31, 2001 plus ≥1 panel before a CV event or study end. Patients were stratified into three baseline cohorts: isolated high LDL-C (Cohort 1), high LDL-C + low HDL-C or high TG (Cohort 2), and high LDL-C, low HDL-C, and high TG (Cohort 3). CV event risk stratified by combined desired lipid value achievement was assessed in each cohort.
Results: Achievement of combined desired lipid values/median days to achievement was 29% in 385 days (Cohort 1), 11% in 413 days (Cohort 2), and 7% in 505 days (Cohort 3). Achievement of combined desired lipid values was associated with an adjusted 25%-46% lower CV event risk in Cohort 1 (hazards ratio, 0.75; 95% confidence interval 0.65-0.87), Cohort 2 (hazards ratio, 0.54; 95% confidence interval 0.43-0.67), and Cohort 3 (hazard ratio, 0.54; 95% confidence interval 0.37-0.78).
Conclusion: Patients with combined desired lipid values had lower risk of CV events versus those without such values. The risk reduction was greatest among patients with multiple lipid abnormalities, suggesting a potential benefit of interventions targeting low HDL-C and/or high TG in addition to high LDL-C.