On-treatment lipid profiles to predict the cardiovascular outcomes in ASCVD patients comorbid with chronic kidney disease – The multi-center T-SPARCLE registry study

Background: The aim of this study is to determine the relationship between the on-treatment lipid profiles and the CV events in CKD and non-CKD population. Method: This study was a multi-center observational registry, the Taiwanese Secondary Prevention for patients with AtheRosCLErotic disease (T-SPARCLE) Registry. This study follows up patients with CV diseases in Taiwan who have secondary prevention therapies. The primary outcome is the time of first occurrence of a major adverse cardiac events (MACEs). Result: 5388 patients with ASCVD were included and 1478 (27.4%) had CKD without dialysis. CKD patients had higher TG and lower LDL-C levels. The incidence of recurrent MACEs per 1000 person-years in CKD patients was 19.5 (95% CI 15.5–24.9), compared with 9.1 (95% CI 7.4–11.1) in non-CKD patients. In patients with statin therapy, there were no differences in MACE risk between each level of on-treatment LDL-C, TG and HDL-C level. Higher on-treatment non-HDL-C level was a significant predictor for higher MACE risk in patients without CKD, and borderline significant in CKD patients under statin therapy. Heart failure history was also associated with higher MACE risk in both group. Lower body mass index (BMI < 23 kg/m²) was associated with higher MACE risk in CKD patients. Conclusion: In ASCVD patients, on-treatment LDL-C was not a good CV outcome predictor. Instead, on-treatment non-HDL-C was a better predictor. Heart failure history was also associated with higher MACE risk in both group of patients. Lower BMI (<23 kg/m²) was associated with higher recurrent MACE risk in CKD patients.