Combined Triglyceride–High-density Lipoprotein Cholesterol Phenotypes and Cardiovascular Outcomes in Japanese Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: Insights from Clinical Deep Data Accumulation System-PCI
Abstract
AIMS: Despite intensive lipid-lowering therapy, residual cardiovascular risk remains prevalent among patients with coronary artery disease. Although triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) metabolism are closely interrelated, their combined prognostic significance in secondary prevention remains unclear. METHODS: This study analyzed the Clinical Deep Data Accumulation System- Percutaneous Coronary Intervention (CLIDAS-PCI) database, a multicenter Japanese registry of patients with acute coronary syndrome undergoing PCI. Patients were stratified into four combined TG-HDL phenotypic groups using guideline-consistent cutoff values for high TG (≥ 175 mg/dL) and low HDL-C (≤ 40 mg/dL) levels. The primary outcome was a composite of major adverse cardiac and cerebrovascular events plus hospitalization for heart failure and its components. RESULTS: Among 3,352 patients, high TG levels were not associated with the composite outcome but were consistently associated with an increased risk of recurrent myocardial infarction. Although low HDL-C levels were associated with increased cardiovascular risk, this association was attenuated after adjustment for renal function and nutritional status. Combined TG-HDL phenotyping revealed distinct risk profiles: patients with high TG and low HDL-C levels had the highest risk of recurrent myocardial infarction, while those with low TG and low HDL-C levels exhibited a markedly higher risk of cardiovascular death. CONCLUSIONS: In a Japanese secondary prevention cohort undergoing PCI, TG and HDLC demonstrated complementary and outcome-specific prognostic associations. Thus, combined TG-HDL phenotyping using guideline-based cutoffs may provide a simple and clinically relevant approach to stratifying residual cardiovascular risk beyond low-density lipoprotein cholesterol lowering.
Related
- Triglyceride-glucose index and risk of major adverse cardiovascular events in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention
- A Chemokine Profile Linked to Both Triglyceride-Rich Lipoproteins and Lipoprotein(a), But Not LDL, Is Associated With Cardiovascular Disease.
- Cardiovascular preventive role of thiazolidinedione in patients with type 2 diabetes mellitus undergoing percutaneous coronary intervention
- Association of Relative LDL-Cholesterol Reduction With Cardiovascular Outcomes After Percutaneous Coronary Intervention
- Effectiveness of a voice-guided tap-and-talk educational tool in enhancing cardiovascular knowledge and self-management in aged patients following percutaneous coronary intervention.
BibTeX
@article{kimura2026combined,
title = {{Combined Triglyceride–High-density Lipoprotein Cholesterol Phenotypes and Cardiovascular Outcomes in Japanese Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: Insights from Clinical Deep Data Accumulation System-PCI}},
author = {Mitsukuni Kimura and Shunsuke Katsuki and Yasuhiro Nakano and Rissei Hino and Takuya Tabuchi and Genryu Mizokami and Keiji Oi and Mitsuhiro Fukata and Takanori Yamashita and Naoki Nakashima and Takahide Kohro and Tomoyuki Kabutoya and Kazuomi Kario and Yasushi Imai and Hideo Fujita and Naoyuki Akashi and Arihiro Kiyosue and Yoshiko Mizuno and Satoshi Kodera and Masaharu Nakayama and Kotaro Nochioka and Yoshihiro Miyamoto and Kenichi Tsujita and Masanobu Ishii and Hisahiko Sato and Kohtaro Abe and Tetsuya Matoba and Ryozo Nagai and on behalf of the CLIDAS research group},
journal = {Journal of Atherosclerosis and Thrombosis},
year = {2026},
month = aug,
doi = {10.5551/jat.66189},
url = {https://www.jstage.jst.go.jp/article/jat/advpub/0/advpub_66189/_article},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Combined Triglyceride–High-density Lipoprotein Cholesterol Phenotypes and Cardiovascular Outcomes in Japanese Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: Insights from Clinical Deep Data Accumulation System-PCI
AU - Mitsukuni Kimura
AU - Shunsuke Katsuki
AU - Yasuhiro Nakano
AU - Rissei Hino
AU - Takuya Tabuchi
AU - Genryu Mizokami
AU - Keiji Oi
AU - Mitsuhiro Fukata
AU - Takanori Yamashita
AU - Naoki Nakashima
AU - Takahide Kohro
AU - Tomoyuki Kabutoya
AU - Kazuomi Kario
AU - Yasushi Imai
AU - Hideo Fujita
AU - Naoyuki Akashi
AU - Arihiro Kiyosue
AU - Yoshiko Mizuno
AU - Satoshi Kodera
AU - Masaharu Nakayama
AU - Kotaro Nochioka
AU - Yoshihiro Miyamoto
AU - Kenichi Tsujita
AU - Masanobu Ishii
AU - Hisahiko Sato
AU - Kohtaro Abe
AU - Tetsuya Matoba
AU - Ryozo Nagai
AU - on behalf of the CLIDAS research group
PY - 2026
DA - 2026/08/25
JO - Journal of Atherosclerosis and Thrombosis
DO - 10.5551/jat.66189
UR - https://www.jstage.jst.go.jp/article/jat/advpub/0/advpub_66189/_article
AB - AIMS: Despite intensive lipid-lowering therapy, residual cardiovascular risk remains prevalent among patients with coronary artery disease. Although triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) metabolism are closely interrelated, their combined prognostic significance in secondary prevention remains unclear. METHODS: This study analyzed the Clinical Deep Data Accumulation System- Percutaneous Coronary Intervention (CLIDAS-PCI) database, a multicenter Japanese registry of patients with acute coronary syndrome undergoing PCI. Patients were stratified into four combined TG-HDL phenotypic groups using guideline-consistent cutoff values for high TG (≥ 175 mg/dL) and low HDL-C (≤ 40 mg/dL) levels. The primary outcome was a composite of major adverse cardiac and cerebrovascular events plus hospitalization for heart failure and its components. RESULTS: Among 3,352 patients, high TG levels were not associated with the composite outcome but were consistently associated with an increased risk of recurrent myocardial infarction. Although low HDL-C levels were associated with increased cardiovascular risk, this association was attenuated after adjustment for renal function and nutritional status. Combined TG-HDL phenotyping revealed distinct risk profiles: patients with high TG and low HDL-C levels had the highest risk of recurrent myocardial infarction, while those with low TG and low HDL-C levels exhibited a markedly higher risk of cardiovascular death. CONCLUSIONS: In a Japanese secondary prevention cohort undergoing PCI, TG and HDLC demonstrated complementary and outcome-specific prognostic associations. Thus, combined TG-HDL phenotyping using guideline-based cutoffs may provide a simple and clinically relevant approach to stratifying residual cardiovascular risk beyond low-density lipoprotein cholesterol lowering.
SN - 1880-3873
SN - 1340-3478
ER -