Dyslipidemia and Lipid-Lowering in Patients with High Risk of Cardiovascular Diseases and Their Cardiovascular Outcomes in Korea (ENSURE study): Secondary Prevention in Chronic Stable Angina

Kyung Taek Park; Sung Gyun Ahn; Sang-Ho Jo; Sungha Park; Hyun Jae Kang; Kwang-Il Kim; Kye Hun Kim; Dong Heon Yang; Sang-Hyun Kim; Ki Hoon Han; In-Kyu Lee

doi:10.12997/jla.2015.4.1.27

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Park, Ahn, Jo, Park, Kang, Kim, Kim, Yang, Kim, Han, and Lee: Dyslipidemia and Lipid-Lowering in Patients with High Risk of Cardiovascular Diseases and Their Cardiovascular Outcomes in Korea (ENSURE study): Secondary Prevention in Chronic Stable Angina

Original Article

Journal of Lipid and Atherosclerosis 2015; 4(1): 27-34.

Published online: 30 June 2015

DOI: https://doi.org/10.12997/jla.2015.4.1.27

Dyslipidemia and Lipid-Lowering in Patients with High Risk of Cardiovascular Diseases and Their Cardiovascular Outcomes in Korea (ENSURE study): Secondary Prevention in Chronic Stable Angina

Kyung Taek Park¹, Sung Gyun Ahn², Sang-Ho Jo³, Sungha Park⁴, Hyun Jae Kang¹, Kwang-Il Kim⁵, Kye Hun Kim⁶, Dong Heon Yang⁷, Sang-Hyun Kim⁸, Ki Hoon Han⁹, In-Kyu Lee⁷

¹Deparment of Internal Medicine, Seoul National University Hospital, Seoul, Korea.

²Deparment of Internal Medicine, Wonju Severance Christian Hospital, WonJu, Korea.

³Deparment of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.

⁴Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.

⁵Deparment of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

⁶Deparment of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea.

⁷Department of Cardiology, Kyungpook National University Hospital, Daegu, Korea.

⁸Deparment of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.

⁹Deparment of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

¹⁰Department of Endocrinology, Kyungpook National University Hospital, Daegu, Korea.

Corresponding Author: Hyun-Kae Kang, Deparment of Internal Medicine, Seoul National University Hospital, 101 Daehang-ro, Chonro-gu, Seoul 110-744, Korea. Tel: +82-2-2072-2279, Fax: +82-2-762-2231, nowkang@snu.ac.kr

Received 16 May 2015 Revised 2 June 2015 Accepted 3 June 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background and Objectives

The aim of this study was to investigate the status of LDL-cholesterol level and its relationship with subsequent cardiovascular events in Korean patients with chronic stable angina.

Methods

The patients with stable angina were retrospectively and consecutively enrolled from out-patients clinic during 2007-2009. Mean follow-up duration was 3 years. Occurrences of major adverse cardio-cerebrovascular event (MACCE: a composite of death, myocardial infarction, unstable angina, coronary revascularization, cerebrovascular events, peripheral artery disease and aortic disease requiring hospital admission.) were compared by initial LDL-cholesterol levels using Cox proportional-hazards model.

Results

1,683 subjects were enrolled from 9 hospitals. Initial median LDL-cholesterol by tertile was 62.2, 90.2, and 124.0mg/dL respectively, however, the differences in LDL-cholesterol level among initial 3 tertile groups became narrow at 3rd year (67.8, 85.0, and 91.6mg/dL, respectively). MACCE occurred in 138 (8.2%) subjects, including 127 coronary events, 9 cerebrovascular events and 2 peripheral artery disease during the 3-year follow-up. The adjusted hazard ratio for MACCE was 1.02 (95% confidence interval 0.64-1.64) in the middle tertile of LDL-cholesterol, 1.53 (p=0.063, 95% Confidence Interval 0.98-2.40) in the highest tertile of LDL-cholesterol. The newly diagnosed diabetes mellitus was more frequent in subjects with statin treatment than subjects without statin during the 3-year follow-up (1.5% vs 0.6%).

Conclusion

Increased cardiovascular risk was observed in angina patients with higher initial LDL-cholesterol levels during the 3-year follow-up, although the differences were statistically insignificant.

Keywords: Angina, Hypercholesterolemia, Secondary prevention, Korean

Figures and Tables

Fig. 1

Serial changes of LDL-C levels in each group by baseline LDL-C during follow-up

Table 1

Baseline characteristics

GFR; glomerulus filtration rate, PCI; percutaneous coronary intervention, CABG; coronary artery bypass graft surgery, ACEI; angiotensin-converting-enzyme inhibitor, ARB; angiotensin receptor blocker, CCB; calcium channel blocker, BB; beta blocker, LDL; low-density lipoprotein, HDL; high-density lipoprotein, hsCRP; high sensitive C-reactive protein

Table 2

Baseline characteristics of tertiles by initial LDL cholesterol level

BMI; body mass index, DM; diabetes mellitus, eGFR; estimated glomerular filtration rate

Table 3

Major adverse cardio-cerebrovascular events (MACCE)

Table 4

Multivariate analysis

DM; diabetes mellitus, LDL-C; Low-density lipoprotein cholesterol

Appendices

Appendix 1

Serial Lipid level follow-up

Appendix Fig. 1

Kaplan-Meier survival curve by initial LDL tertiles.

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