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Sci Rep. 2017 Aug 23;7(1):9179. doi: 10.1038/s41598-017-08741-0.

Residual Risk Factors to Predict Major Adverse Cardiovascular Events in Atherosclerotic Cardiovascular Disease Patients with and without Diabetes Mellitus.

Lin FJ1,2,3, Tseng WK4,5, Yin WH6,7, Yeh HI8, Chen JW9,10, Wu CC11,12.

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Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan.
Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan.
Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan.
School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Mackay Memorial Hospital, Mackay Medical College, New Taipei City, Taiwan.
Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan.
Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan.
Department of Internal Medicine (Cardiology Section), National Taiwan University Hospital, Taipei, Taiwan.
Graduate Institute of Medical Education & Bioethics, College of Medicine, National Taiwan University, Taipei, Taiwan.


A prospective observational study was conducted to investigate the residual risk factors to predict recurrence of major adverse cardiovascular events (MACE) in atherosclerotic cardiovascular disease (ASCVD) patients with a high prevalence under lipid-lowering therapy, particularly in the subpopulations of diabetic and nondiabetic individuals. A total of 5,483 adults (with a mean age of 66.4 and 73.3% male) with established coronary heart disease, cerebrovascular disease, or peripheral artery disease were identified from the T-SPARCLE multi-center registry. Of them, 38.6% had diabetes. The residual risk factors for MACE are divergent in these atherosclerotic patients with and without diabetes. In diabetic subpopulation, the risk of MACE was significantly increased with heart failure (HF), chronic kidney disease (CKD) stage 4-5 (vs. stage 1-2), without beta blocker use, and higher non-HDL-C, after controlling for covariates including statin use and the intensity of therapy. Increased LDL-C and TG levels were also associated with increased risk, but to a much less extent. Among nondiabetic individuals, HF, CKD stage 4-5, and history of myocardial infarction were the significant independent predictors of MACE. It is suggested that ASCVD patients with concomitant diabetes need stricter control of lipid, particularly non-HDL-C levels, to reduce cardiovascular risk when on statin therapy.

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