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Abstract
In patients with atherosclerotic cardiovascular disease (ASCVD) under statin treatment, the influence of on-treatment level of high-density lipoprotein cholesterol (HDL-C) on cardiovascular (CV) events is controversial. Statin-treated patients were selected from the Taiwanese Secondary Prevention for patients with AtheRosCLErotic disease (T-SPARCLE) Registry, a multicenter, observational study of adult patients with ASCVD in Taiwan. Low HDL-C was defined as < 40 mg/dL for men and < 50 mg/dL for women. The primary outcome was a composite CV events including CV death, myocardial infarction (MI), stroke or cardiac arrest with resuscitation. A total of 3731 patients (mean age 65.6 years, 75.6% men) were included. Patients with on-treatment low HDL-C (44%, mean HDL-C 34.9 ± 6.8 mg/dL) were younger and with more diabetes and higher body weight. The mean follow-up time was 2.7 years. We used restricted cubic spline curves to examine the potential non-linear association between HDL-C and adverse outcomes. Decreased HDL-C levels were associated with a significantly increased risk of CV events in women (< 49 mg/dL in women) but not in men (< 42 mg/dL in men). However, the protective effect of elevated HDL-C levels was more prominent in men than in women. In ASCVD patients with statin therapy, low on-treatment HDL-C was common in Taiwan and associated with an increased risk of CV events in women. Higher HDL-C levels provided more protective effect in men than in women.
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1 National Cheng Kung University, Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, Tainan, Taiwan (GRID:grid.64523.36) (ISNI:0000 0004 0532 3255)
2 I-Shou University, Department of Medical Imaging and Radiological Sciences, Kaohsiung, Taiwan (GRID:grid.411447.3) (ISNI:0000 0004 0637 1806); E-Da Hospital, Division of Cardiology, Department of Internal Medicine, Kaohsiung, Taiwan (GRID:grid.414686.9) (ISNI:0000 0004 1797 2180)
3 National Yang Ming University School of Medicine, Taipei, Taiwan (GRID:grid.260770.4) (ISNI:0000 0001 0425 5914); Cheng-Hsin General Hospital, Division of Cardiology, Heart Center, Taipei, Taiwan (GRID:grid.413846.c) (ISNI:0000 0004 0572 7890)
4 National Taiwan University, Graduate Institute of Clinical Pharmacy and School of Pharmacy, College of Medicine, Taipei, Taiwan (GRID:grid.19188.39) (ISNI:0000 0004 0546 0241); National Taiwan University Hospital, Department of Pharmacy, Taipei, Taiwan (GRID:grid.412094.a) (ISNI:0000 0004 0572 7815)
5 Far Eastern Memorial Hospital, Cardiology Division, Cardiovascular Medical Center, New Taipei City, Taiwan (GRID:grid.414746.4) (ISNI:0000 0004 0604 4784); Taipei Veterans General Hospital, Department of Medical Research and Education, Taipei, Taiwan (GRID:grid.278247.c) (ISNI:0000 0004 0604 5314); National Taiwan University Hospital and National Taiwan University College of Medicine, Cardiology Division, Department of Internal Medicine, Taipei, Taiwan (GRID:grid.19188.39) (ISNI:0000 0004 0546 0241)
6 Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Division of Cardiology, Department of Internal Medicine, Taoyuan, Taiwan (GRID:grid.145695.a)
7 Kaohsiung Medical University Hospital, Division of Cardiology, Department of Internal Medicine, Kaohsiung, Taiwan (GRID:grid.412027.2) (ISNI:0000 0004 0620 9374); Kaohsiung Medical University, Faculty of Medicine, College of Medicine, Kaohsiung, Taiwan (GRID:grid.412019.f) (ISNI:0000 0000 9476 5696)
8 Taichung Veterans General Hospital, Division of Endocrinology and Metabolism and Department of Medical Research, Taichung, Taiwan (GRID:grid.410764.0) (ISNI:0000 0004 0573 0731)
9 Mackay Medical College, Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, New Taipei City, Taiwan (GRID:grid.452449.a) (ISNI:0000 0004 1762 5613)
10 National Yang Ming University, Institute of Pharmacology, Taipei, Taiwan (GRID:grid.260770.4) (ISNI:0000 0001 0425 5914)
11 National Taiwan University Hospital and National Taiwan University College of Medicine, Cardiology Division, Department of Internal Medicine, Taipei, Taiwan (GRID:grid.19188.39) (ISNI:0000 0004 0546 0241); National Taiwan University, Graduate Institute of Medical Education and Bioethics, College of Medicine, Taipei, Taiwan (GRID:grid.19188.39) (ISNI:0000 0004 0546 0241)