Cor Vasa 2014, 56(2):e98-e104 | DOI: 10.1016/j.crvasa.2014.02.002

Residual cardiovascular risk in patients with stable coronary heart disease over the last 16 years (Czech part of the EUROASPIRE I-IV surveys)

Barbora Nussbaumerová^a,*, Hana Rosolová^a, Otto Mayer jr.^a, Jan Filipovský^a, Renata Cífková^b, Jan Bruthans^b

^a Centrum preventivní kardiologie, II. interní klinika, Lékařská fakulta Plzeň, Univerzita Karlova v Praze a Fakultní nemocnice Plzeň, Plzeň, Česká republika

^b Centrum kardiovaskulární prevence, 1. lékařská fakulta Univerzity Karlovy a Thomayerova nemocnice, Praha, Česká republika

Introduction: Many patients with coronary heart disease (CHD) who achieve target low density lipoprotein cholesterol (LDL-C) values still experience vascular events because of a residual vascular risk due to other risk factors, particularly non-LDL-C dyslipidemia, because of non-adherence to non-pharmacological and pharmacological management.
Method and aims: We used simple markers and inexpensive screening tools for metabolic disorders associated with insulin resistance and metabolic syndrome identifying subjects at a high cardiovascular (CV) risk - atherogenic dyslipidemia (triglycerides [TG] ≥2.0 mmol/l and high-density lipoprotein cholesterol [HDL-C] ≤1.0 mmol/l in males and ≤1.2 mmol/l in females), hypertriglyceridemic waist (TG ≥2.0 mmol/l and waist circumference ≥90 cm in males and ≥85 cm in females), atherogenic index of plasma (AIP = log [TG/HDL-C]) and non-HDL-C (non-HDL-C = total cholesterol - HDL-C)]. We focused on the development of these risk factors among patients with established stable CHD over more than the last 16 years.

Results: We examined 1 484 patients, 1 152 males (78%) and 332 females (22%) from the Czech parts of EUROASPIRE I-IV (EA I-IV) surveys. In males, TG, HDL-C, and non-HDL-C decreased significantly from EA I to IV (p for trends NS; 0.0001; 0.0001, respectively). In females, there was no change in TG; HDL-C, and non-HDL-C decreased significantly (p for trends NS; 0.03; 0.0001, respectively). Atherogenic dyslipidemia prevalence decreased significantly in both sexes (p for trends 0.004 and 0.0012, respectively). Hypertriglyceridemic waist prevalence showed no change in either sex. There were no significant changes in AIP risk strata in either sex. About 30-40% of males and 24-30% of females had their AIP in the high-risk strata, which tended to increase in males. The prevalence of type 2 diabetes (T2DM) and waist circumference increased significantly from EAI to IV (from 23% to 48%, and from 98 cm to 105 cm, respectively; both p for trend

Keywords: Atherogenic dyslipidemia; Atherogenic index of plasma; Glucose metabolism disorders; Hypertriglyceridemic waist; Residual vascular risk; Stable coronary heart disease

Received: January 15, 2014; Accepted: February 3, 2014; Published: April 1, 2014  Show citation