La dislipidemia aterogenica e il rischio residuo cardiovascolare nella patologia cerebrovascolare

Background: Treatment with statins reduces the rate of cardiovascular events in high-risk patients, but residual risk persists. At least part of that risk may be attributable to atherogenic dyslipidemia (AD) characterized by low high-density lipoprotein cholesterol (HDL-C) and high triglycerides. Methods and results: We studied subjects with stroke or TIA in the PERFORM (n=19,100) and SPARCL (n=4,731) trials who were treated with a statin and who had AD (HDL-C ≤40 mg/dL and triglycerides ≥150 mg/dL) 3-months after randomization (n=10,498 and 2,900 respectively). The primary outcome measure for this exploratory analysis was the occurrence of major cardiovascular events (MVEs; nonfatal myocardial infarction, nonfatal stroke or cardiovascular death). We also performed a time-varying analysis to account for all available HDL-C and triglyceride measures. 11% of subjects in PERFORM and 9% in SPARCL had AD after at least 3 months on statin therapy. After a follow-up of 2.3-years (PERFORM) and 4.9-years (SPARCL), a MVE occurred in 1,123 and 485 patients in the two trials, respectively. The risk of MVEs was higher in subjects with versus those without AD in both PERFORM (hazard ratio [HR]=1.36, 95% confidence interval [CI]=1.14-1.63) and SPARCL (HR=1.40, 95%CI=1.06-1.85). The association was attenuated after multivariable adjustment (HR=1.23, 95%CI=1.03-1.48 in PERFORM; HR=1.24; 95%CI= 0.93-1.65 in SPARCL). Time-varying analysis confirmed these findings. Conclusions: The presence of atherogenic dyslipidemia was associated with higher residual cardiovascular risk in PERFORM and SPARCL subjects with stroke or TIA receiving statin therapy. Specific therapeutic interventions should now be trialed to address this residual risk.