{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T08:46:23Z","timestamp":1777797983604,"version":"3.51.4"},"reference-count":33,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2016,5,13]],"date-time":"2016-05-13T00:00:00Z","timestamp":1463097600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2016,6]]},"abstract":"ABSTRACT<\/jats:title>Background<\/jats:title>Low levels of high\u2010density lipoprotein cholesterol (HDL<\/jats:styled-content>\u2010C; <40\u2009mg\/dL<\/jats:styled-content>) are associated with increased risk of cardiovascular events, but it is unclear whether lower thresholds (<30\u2009mg\/dL<\/jats:styled-content>) are associated with increased hazard.<\/jats:p><\/jats:sec>Hypothesis<\/jats:title>Very low levels of HDL<\/jats:styled-content>\u2010C may provide prognostic information in acute coronary syndrome (ACS<\/jats:styled-content>) patients treated medically without revascularization.<\/jats:p><\/jats:sec>Methods<\/jats:title>We examined data from 9064\/9326 ACS<\/jats:styled-content> patients enrolled in the TRILOGY ACS<\/jats:styled-content> trial. Participants were randomized to clopidogrel or prasugrel plus aspirin. Study treatments continued for 6 to 30 months. Relationships between baseline HDL<\/jats:styled-content>\u2010C and the composite of cardiovascular death, myocardial infarction (MI<\/jats:styled-content>), or stroke, and individual endpoints of death (cardiovascular and all\u2010cause), MI<\/jats:styled-content>, and stroke, adjusted for baseline characteristics through 30 months, were analyzed. The HDL<\/jats:styled-content>\u2010C was evaluated as a dichotomous variable\u2014very low (<30\u2009mg\/dL<\/jats:styled-content>) vs higher (\u226530\u2009mg\/dL<\/jats:styled-content>)\u2014and continuously.<\/jats:p><\/jats:sec>Results<\/jats:title>Median baseline HDL<\/jats:styled-content>\u2010C was 42\u2009mg\/dL<\/jats:styled-content> (interquartile range, 34\u201349\u2009mg\/dL<\/jats:styled-content>) with little variation over time. Frequency of the composite endpoint was similar for very low vs higher baseline HDL<\/jats:styled-content>\u2010C, with no risk difference between groups (hazard ratio [HR<\/jats:styled-content>]: 1.13, 95% confidence interval [CI<\/jats:styled-content>]: 0.95\u20101.34). Similar findings were seen for MI<\/jats:styled-content> and stroke. However, risks for cardiovascular (HR<\/jats:styled-content>: 1.42, 95% CI<\/jats:styled-content>: 1.13\u20101.78) and all\u2010cause death (HR<\/jats:styled-content>: 1.36, 95% CI<\/jats:styled-content>: 1.11\u20101.67) were higher in patients with very low baseline HDL<\/jats:styled-content>\u2010C.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Medically managed ACS<\/jats:styled-content> patients with very low baseline HDL<\/jats:styled-content>\u2010C levels have higher risk of long\u2010term cardiovascular and all\u2010cause death but similar risks for nonfatal ischemic outcomes vs patients with higher baseline HDL<\/jats:styled-content>\u2010C.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.22533","type":"journal-article","created":{"date-parts":[[2016,5,13]],"date-time":"2016-05-13T16:15:29Z","timestamp":1463156129000},"page":"329-337","source":"Crossref","is-referenced-by-count":10,"title":["Association Between Very Low Levels of High\u2010Density Lipoprotein Cholesterol and Long\u2010term Outcomes of Patients With Acute Coronary Syndrome Treated Without Revascularization: Insights From the TRILOGY ACS<\/scp> Trial"],"prefix":"10.1002","volume":"39","author":[{"given":"Emil","family":"Hagstr\u00f6m","sequence":"first","affiliation":[{"name":"Department of Medical Sciences Uppsala Clinical Research Center, Uppsala University Uppsala Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew T.","family":"Roe","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Duke Clinical Research Institute, Duke University School of Medicine Durham North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gail","family":"Hafley","sequence":"additional","affiliation":[{"name":"Department of Statistics, Duke Clinical Research Institute Duke University School of Medicine Durham North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan L.","family":"Neely","sequence":"additional","affiliation":[{"name":"Department of Statistics, Duke Clinical Research Institute Duke University School of Medicine Durham North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mandeep S.","family":"Sidhu","sequence":"additional","affiliation":[{"name":"Department of Medicine, Albany Stratton VA Medical Center and Albany Medical Center Albany Medical College Albany New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth J.","family":"Winters","sequence":"additional","affiliation":[{"name":"Eli Lilly and Company (Winters) Indianapolis Indiana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorairaj","family":"Prabhakaran","sequence":"additional","affiliation":[{"name":"Centre for Chronic Disease Control and Public Health Foundation of India New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harvey D.","family":"White","sequence":"additional","affiliation":[{"name":"Green Lane Cardiovascular Service Auckland City Hospital Auckland New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul W.","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine\/Canadian VIGOUR Centre University of Alberta Edmonton Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keith A.A.","family":"Fox","sequence":"additional","affiliation":[{"name":"Centre for Cardiovascular Science University of Edinburgh Edinburgh Scotland United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E. 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