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Dyslipidemia is associated with increased heart failure (HF) risk. Lipid-modifying therapy is prescribed for primary prevention of coronary heart disease (CHD). Whether treatment-induced improvement in lipid profile in this setting is also associated with decreased HF risk is unclear.
In 18,402 CHD-free Veteran males (mean age 68 years) receiving lipid-modifying therapy, we assessed the magnitude of treatment-induced improvement (“delta [d]” = post-treatment value – pretreatment value) in high-density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and triglycerides (TG). We related quintiles of d-HDL-C, d-LDL-C and d-TG to risk of incident HF, using multivariable-adjusted Cox proportional hazards models.
Over a maximum follow-up period of 9 years, 911 HF events occurred. There was a graded decrease in HF risk across quintiles of increasing HDL-C improvement. Compared to patients in the first quintile, improvement in HDL-C was associated with up to 30% decrease in HF hazards (Table). Analyses adjusting for interim CHD events, or excluding participants developing interim CHD events showed similar Results. Delta-LDL-C and delta-TG were not associated with any meaningful improvement in HF incidence.
HDL-C improvement (but not LDL-C or TG lowering) was associated with decrease in incident HF. Our findings suggest HDL-C modification may have potential for primary prevention of HF in individuals free of CHD.
|Quintile 1||Quintile 2||Quintile 3||Quintile 4||Quintile 5|
|No. of events/no. at risk (%)||167/3524 (4.7%)||192/4004 (4.8%)||163/3374 (4.8%)||189/3698 (5.1%)||200/3802 (5.3%)|
|Hazards ratio (95% CI)||Referent||0.77 (0.62, 0.95)||0.69 (0.55, 0.87)||0.67 (0.53, 0.83)||0.70 (0.56, 0.88)|
CI = confidence interval; hazards ratios are adjusted for age, hypertension, diabetes, body mass index and baseline lipids.
Moderated Poster Contributions
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Prevention: Risk Assessment in Primary Prevention
Abstract Category: 24. Prevention: Clinical
Presentation Number: 1232M-8
- 2013 American College of Cardiology Foundation