Peripheral microvascular dysfunction predicts residual risk in coronary artery disease patients on statin therapy |
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Authors: | Yuya Matsue Kazuki Yoshida Wataru Nagahori Masakazu Ohno Makoto Suzuki Akihiko Matsumura Yuji Hashimoto Masayuki Yoshida |
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Institution: | 1. Department of Cardiology, Kameda Medical Center, Chiba, Japan;2. Life Science and Bioethics Research Center, Tokyo Medical and Dental University, Tokyo, Japan;3. Department of Rheumatology, Kameda Medical Center, Chiba, Japan;4. Harvard School of Public Health, Boston, MA, USA |
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Abstract: | ObjectiveAlthough lowering of low-density lipoprotein cholesterol (LDL-C) by statins is essential in treatment of coronary artery disease (CAD) patients, there is considerable residual risk of secondary coronary artery events (CAE). We examined whether microvascular dysfunction (MiD), measured by peripheral artery tonometry (PAT), can predict prognosis of CAD patients previously treated with statins.MethodsWe measured log-transformed reactive hyperemia index (L_RHI) in 213 CAD patients who had already achieved LDL-C <100 by statin therapy. Patients were followed-up for secondary CAE for a median of 2.7 years. Patients were divided into two groups: L_RHI ≥ 0.54 (n = 99) and L_RHI < 0.54 (n = 114).ResultsDuring follow-up, CAE occurred in 4 (4.0%) patients in the L_RHI ≥ 0.54 group and 18 (15.8%) patients in the L_RHI < 0.54 group (P = 0.006). Cox regression analysis indicated that L_RHI was an independent predictor for CAE even after adjustment by Framingham traditional risk factors (FRF; age, T-C/HDL-C ratio, systolic blood pressure, diabetes, current smoker, and gender) and estimated glomerular filtration rate (eGFR) for secondary CAE (HR 0.79, 95% CI: 0.66–0.95). ROC analysis for CAE prediction showed that the AUC for models including FRF only, FRF + eGFR, and FRF + eGFR + L_RHI were 0.60, 0.71, and 0.77, respectively. Moreover, adding eGFR to FRF only (0.63, P = 0.003) and adding L_RHI to the FRF + eGFR model were associated with significant improvement of net reclassification improvement (0.79, P = 0.007).ConclusionMiD measured by non-invasive PAT adds incremental predictive ability to traditional risk factors for prognosis of CAD patients successfully treated with statins. |
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Keywords: | Coronary artery disease Statin Microvascular dysfunction Noninvasive Optimal medical therapy |
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