演題

Fundamental Differences in Conventional Risk Factors for Secondary Prevention in Patients with Acute Coronary Syndrome: A Post-hoc Analysis of HIJ-PROPER

[演者] Haruki Sekiguchi:1
[共同演者] Masataka Ogiso:1, Erisa Watanabe:1, Hiroyuki Arashi:1, Junichi Yamaguchi:1, Hiroshi Ogawa:1, Nobuhisa Hagiwara:1
1:Department of Cardiology, Tokyo Women's Medical University, Tokyo

Introduction:Strict risk factor control is important for prevention of cardiovascular disease(CVD). However,which risk factor is the key element for prevention of CVD in patients with dyslipidemia treated adequately with statin therapy is unknown.Methods:The HIJ-PROPER study prospectively enrolled 1,734 patients with acute coronary syndrome(ACS) with concurrent dyslipidemia. During index hospitalization, 1638 patients(95.2%) underwent primary coronary revascularization. Participants were randomly assigned to receive pitavastatin only or pitavastatin in combination with ezetimibe. The primary endpoint was a composite of all-cause death,non-fatal myocardial infarction,non-fatal stroke,unstable angina,and ischemia-driven revascularization. In the present study,we evaluated conventional risk factors,viz., hypertension(HTN),type 2 diabetes mellitus(T2DM),chronic kidney disease(CKD;estimated glomerular filtration rate<60mL/min/1.73m2),and smoking in terms of endpoint.Results:During the observation period,the primary endpoint was documented in 316 patients. Multivariate Cox regression analysis revealed that T2DM,smoking,and CKD were independent risk factors for the primary endpoint [hazard ratio(HR):1.42,95% confidence interval(CI):1.20-1.68,P<0.01,HR:1.20,95% CI:1.02-1.42, P<0.03,HR:1.21,95% CI:1.01-1.45,P=0.04],respectively. However,HTN was not an independent risk factor for the primary endpoint.In T2DM patients,the HR was increased to 1.70(95% CI:1.29-2.22,P<0.001) or 1.48(95% CI:1.14-1.91, P=0.003) when the patient had concurrent CKD or was a smoker. In CKD patients,the HR increased to 1.48 (95% CI:1.14-1.92,P=0.003) when the patient was a smoker. Conclusions:The present results suggest that T2DM could be considered a strongly decisive risk factor for cardiovascular events in patients with ACS with concurrent dyslipidemia despite the availability of acute revascularization in present times.

[Keywords] acute coronary syndrome / risk factor
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