ArticleJournal of the American College of Cardiology2013
Low levels of high-density lipoprotein cholesterol and increased risk of cardiovascular events in stable ischemic heart disease patients: A post-hoc analysis from the COURAGE Trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation).
Article in Journal of the American College of Cardiology, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00007657 (CSP #424 - Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation), which is not on this map. Cited by 38 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
CSP #424 - Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation
Who cites it
38 citing papers in PubMed, 108 citations in OpenAlex.
- Risk stratification of ST-segment elevation myocardial infarction (STEMI) patients using machine learning based on lipid profiles.Lipids in health and disease · 2021Trial
- Trial
- Association Between Very Low Levels of High-Density Lipoprotein Cholesterol and Long-term Outcomes of Patients With Acute Coronary Syndrome Treated Without Revascularization: Insights From the TRILOGY ACS Trial.Clinical cardiology · 2016Trial
- Diagnostic and Severity Assessment of Coronary Artery Disease Using ApoB/ApoA-I Ratio: Insights from a Statin-Treated Eastern European Cohort.Medicina (Kaunas, Lithuania) · 2026Article
- Elevated atherogenic index of plasma is associated with increased cardiorenal syndrome prevalence: a cross-sectional study.Renal failure · 2025Article
- Optimizing Long-term Cardiovascular Risk Stratification: Integrating Biomarkers into the Very High-Risk ASCVD Definition in Asian Patients.American journal of preventive cardiology · 2025Article
- Bridging the gap between CVD and COVID-19: the oxidized LDL hypothesis.Frontiers in medicine · 2025Article
- Dynamics of HDL-Cholesterol Following a Post-Myocardial Infarction Cardiac Rehabilitation Program.Reviews in cardiovascular medicine · 2025Article
- Does Elevated High-Density Lipoprotein Cholesterol Protect Against Cardiovascular Disease?The Journal of clinical endocrinology and metabolism · 2024Article
- High-Density Lipoprotein Cholesterol in Atherosclerotic Cardiovascular Disease Risk Assessment: Exploring and Explaining the "U"-Shaped Curve.Current cardiology reports · 2023Review
- In Mild and Moderate Acute Ischemic Stroke, Increased Lipid Peroxidation and Lowered Antioxidant Defenses Are Strongly Associated with Disabilities and Final Stroke Core Volume.Antioxidants (Basel, Switzerland) · 2023Article
- Novel grading system for ischemia‒reperfusion injury manifestations in patients with acute ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention.Scientific reports · 2022Article
- Complex association of apolipoprotein E-containing HDL with coronary artery disease burden in cardiovascular disease.JCI insight · 2022Observational
- Phytonutrients of Bitter Apricot Seeds Modulate Human Lipid Profile and LDL Subfractions in Adults with Elevated Cholesterol Levels.International journal of environmental research and public health · 2022Article
- Levels of miR-130b-5p in peripheral blood are associated with severity of coronary artery disease.Molecular biology reports · 2021Article
- High serum high-density lipoprotein and low serum triglycerides in Kratom users: A study of Kratom users in Thailand.Heliyon · 2021Article
- BMI modifies the association between serum HDL cholesterol and stroke in a hypertensive population without atrial fibrillation.Journal of endocrinological investigation · 2021Article
- COVID-19-Associated dyslipidemia: Implications for mechanism of impaired resolution and novel therapeutic approaches.FASEB journal : official publication of the Federation of American Societies for Experimental Biology · 2020Article
- High-Risk Atherosclerosis and Metabolic Phenotype: The Roles of Ectopic Adiposity, Atherogenic Dyslipidemia, and Inflammation.Metabolic syndrome and related disorders · 2020Review
- High-density lipoprotein cholesterol concentration and acute kidney injury after noncardiac surgery.BMC nephrology · 2020Article
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Authors and funding
12 authors at 11 institutions in 2 countries.
Funding
Abstract
objectivesThis study sought to assess the independent effect of high-density lipoprotein-cholesterol (HDL-C) level on cardiovascular risk in patients with stable ischemic heart disease (SIHD) who were receiving optimal medical therapy (OMT).
backgroundAlthough low HDL-C level is a powerful and independent predictor of cardiovascular risk, recent data suggest that this may not apply when low-density lipoprotein-cholesterol (LDL-C) is reduced to optimal levels using intensive statin therapy.
methodsWe performed a post-hoc analysis in 2,193 men and women with SIHD from the COURAGE trial. The primary outcome measure was the composite of death from any cause or nonfatal myocardial infarction (MI). The independent association between HDL-C levels measured after 6 months on OMT and the rate of cardiovascular events after 4 years was assessed. Similar analyses were performed separately in subjects with LDL-C levels below 70 mg/dl (1.8 mmol/l).
resultsIn the overall population, the rate of death/MI was 33% lower in the highest HDL-C quartile as compared with the lowest quartile, with quartile of HDL-C being a significant, independent predictor of death/MI (p = 0.05), but with no interaction for LDL-C category (p = 0.40). Among subjects with LDL-C levels <70 mg/dl, those in the highest quintile of HDL-C had a 65% relative risk reduction in death or MI as compared with the lowest quintile, with HDL-C quintile demonstrating a significant, inverse predictive effect (p = 0.02).
conclusionsIn this post-hoc analysis, patients with SIHD continued to experience incremental cardiovascular risk associated with low HDL-C levels despite OMT during long-term follow-up. This relationship persisted and appeared more prominent even when LDL-C was reduced to optimal levels with intensive dyslipidemic therapy. (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation; NCT00007657).
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.