Residual cardiovascular risk in patients with stable coronary heart disease over the last 16 years (Czech part of the EUROASPIRE I-IV surveys)
Abstrakt
Many patients with coronary heart disease (CHD) who achieve target LDL-C values still have vascular events because of a residual vascular risk due to other risk factors. 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, hypertriglyceridemic waist, atherogenic index of plasma.
We focused on the development of these risk factors in established stable CHD over more than the last 16 years. We examined 1484 patients, 1152 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. In females, there was no change in TG; HDL-C, and non-HDL-C decreased significantly.
Atherogenic dyslipidemia prevalence decreased significantly in both sexes. 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. The prevalence of all above mentioned residual vascular risk markers was higher in patients with T2DM and impaired fasting glucose than in those with normal fasting glucose in both sexes.Despite the increase in T2DM prevalence and waist circumference, hypertriglyceridemic waist prevalence showed no change and atherogenic dyslipidemia prevalence decreased significantly in both sexes, because not all obese patients are insulin-resistant and not all patients with glucose metabolism disorders present all characteristics of metabolic syndrome.
Simple markers of the atherogenic phenotype, especially AIP, should be used in CV risk assessment.