Atherogenic Ratios in Patients with Recurrent Acute Coronary Syndrome and Receiving Statin Therapy: Clinical Usefullness as Cardiovascular Predictors Maria Ferrer Civeira 1 , Juan Pedro-Botet 2,3 , Xavier Pintó 4 , Manuel Zúñiga 5 , Alipio Mangas 6 , Antonio Hernandez-Mijares 7 , Emili Corbella 4 , and Jesus Millan Nuñez-Cortes 1,8* 1 Vascular Risk and Lipid Unit, Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain 2 Vascular Risk and Lipid Unit, Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain 3 Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain 4 Vascular Risk and Lipid Unit, Department of Internal Medicine, Hospital de Belvitge, Barcelona, Spain 5 Vascular Risk and Lipid Unit, Department of Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain 6 Lipid Unit, Department of Internal Medicine, Hospital Universitario Puerta del Mar, Cádiz, Spain 7 Lipid Unit, Department of Endocrinology, Hospital Universitario Dr. Peset, Valencia, Spain 8 Department of Medicine, Faculty of Medicine at the Universidad Complutense, Madrid, Spain * Corresponding author: Jesús Millán Núñez-Cortés, Vascular Risk and Lipid Unit, Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Faculty of Medicine at the Universidad Complutense, Dr. Esquerdo 46. 28007 Madrid, Spain; Tel- 91 394 1325, E-mail: jesus.millan.nunezcortes@madrid.org Received date: July 09, 2014; Accepted date: February 05, 2015; Published date: February 14, 2015 Copyright: © 2015 Civeira MF et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Patients who have already suffered a vascular event require more and better control of cardiovascular risk factors. Different atherogenic indexes such as TC/HDLc, LDLc/HDLc, apoB/apoA-I, LDLc/apoB and non-HDLc/HDLc have been used to follow-up the patients because of their predictive capacity of the lipid profile. The aim of this study was to evaluate atherogenic ratios as a marker of the lipid residual risk in high-risk patients receiving statin therapy and to know the changes produced by previous lipid-lowering drugs treatment for a previous coronary event. The study including patients admitted to coronary care units of six Spanish tertiary hospitals for Acute Coronary Syndrome (ACS). A total of 633 ACS patients were included; of these, 478 (75.8%) had presented a myocardial infarction and 153 (24.2%) angina. A previous ACS had occurred in 43.1% of cases, and was the first episode in 56.9% of the studied patients. Among patients with known ischemic heart disease, 187 (52.2%) were receiving lipid-lowering drugs, mainly statins (182 patients, 50.7%). Of those with a first ACS, 59 (21.7%) were on lipid-lowering drugs: 55 (20.1%) statins and 4 (1.7%) fibrates. Patients with recurrent ACS had similar triglyceride and HDLc levels, but significantly lower total cholesterol and LDLc concentrations compared with those presenting the first ACS. Patients with recurrent ACS had significantly lower non-HDLc levels, TC/HDLc and LDLc/HDLc, but higher HDLc/TC and HDLc/LDLc ratios compared with first ACS patients. In patients taking statins the lipid residual vascular risk was related with the persistence of cardiovascular risk factors, and related with lipid profile with dyslipemia no-LDL dependent. So, we can conclude that the correction of lipid profile by statin is not per se sufficient to control cardiovascular risk. Introduction Cardiovascular disease is the major cause of premature death in Spain, as in other western countries, and underlies a great deal of disability. Consequently, patients who have already suffered a vascular event require more and better risk control [1]. Although low-density lipoprotein cholesterol (LDLc) is the traditional marker for cardiovascular risk and monitoring of statin therapy, it has been emphasized that cardiovascular disease management based exclusively on this lipid parameter might not be sufficient [2,3]. For this reason, therapeutic guidelines, though based on LDLc as the principal target of lipid-lowering therapy, also consider other lipid factors like non High- Density Lipoprotein cholesterol (HDLc), apoprotein (apo) B, apo A-I and the total cholesterol (TC)/HDLc, some of which can be better predictors of cardiovascular risk than LDLc alone [4,5]. However, debate on the choice of the best lipid parameter has intensified, with apparently conflicting evidence among prospective studies [6-8]. Different atherogenic indexes such as TC/HDLc, LDLc/HDLc, apoB/apoA-I, LDLc/apoB and non-HDLc/HDLc have been defined in an attempt to optimize the predictive capacity of the lipid profile [9], the efficiency of which has been demonstrated [10-12]. Although these indexes can provide information on risk factors difficult to quantify by routine analysis, and could better mirror the metabolic and clinical interactions among lipid fractions, they are under-used in cardiovascular disease prevention. Thus, the aim of the present study was to establish atherogenic ratios, as a marker of the atherogenicity/anti-atherogenicity balance in patients with high vascular risk receiving statin therapy, for detecting the treatable residual risk. To this end, in a cohort of Spanish patients Clinical & Experimental Cardiology Nuñez-Cortes, et al., J Clin Exp Cardiolog 2015, 6:2 http://dx.doi.org/10.4172/2155-9880.1000358 Research Article Open Access J Clin Exp Cardiolog ISSN:2155-9880 JCEC, an open access journal Volume 6 • Issue 2 • 1000358