Baseline lipid profile is associated with adverse outcomes in adults with coronary artery disease and obstructive sleep apnea despite lipid-lowering drugs and CPAP treatment: A secondary analysis of the RICCADSA cohort

Abstract

Background: Reducing lipid levels is essential for preventing major adverse cardiovascular and cerebrovascular events (MACCE) in management of coronary artery disease (CAD) patients with obstructive sleep apnea (OSA). The first line treatment of OSA is continuous positive airway pressure (CPAP), however, its impact on the association between lipid profile and MACCEs is uncertain. Methods: This was a secondary analysis of the RICCADSA cohort. In all, 224 revascularized CAD patients with OSA (apnea-hypopnea index [AHI] >= 15 events) were allocated to CPAP, 103 to no-CPAP, and 86 patients had no OSA (AHI<5/h). All patients were on lipid-lowering medication. Circulating triglycerides (TG), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels (all in mg/dL) were measured at baseline and after one year. The undesired TG levels were defined as circulating TG >= 150 mg/dL, and undesired LDL levels were defined as >= 70 mg/dL. Results: OSA patients had higher TG and lower HDL levels than no-OSA patients whereas LDL levels were similar at baseline. There were no significant within-group differences in the CPAP group, no-CPAP group and no-OSA group regarding the lipid levels after one year. Undesired LDL levels at baseline predicted MACCEs med Hazard Ratio 2.18 (%95 CI 1.03-4.60; p = 0.04.) Conclusions: Most of the RICCADSA cohort had undesired LDL levels at baseline despite statin treatment, and CPAP had no additional lipid lowering effect after one year, suggesting that a more aggressive lipid lowering therapy as well as a more effective OSA treatment in addition to lifestyle changes should be targeted in the management of CAD patients with concomitant OSA.