Predictive and protective role of high-density lipoprotein cholesterol in acute myocardial infarction
Abstract
Background: It is unclear whether high-density lipoprotein cholesterol (HDL-C) level predicts cardiovascular events and has a protective effect in patients with acute myocardial infarction (AMI) undergo- ing percutaneous coronary intervention (PCI) and statin treatment.
Methods: A total of 15,290 AMI patients receiving statins were selected from the Korean Myocardial Infarction Registry. Baseline HDL-C level was used to identify patients with low (group A), normal (group B), and high (group C) HDL-C levels according to the Adult Treatment Panel III criteria. Clinical outcomes were compared in propensity-adjusted and matched cohorts. The primary endpoint was a composite of cardiovascular death and recurrent myocardial infarction.
Results: At the median follow-up of 11.5 months, the primary endpoint occurred in 2.7% (112/4098), 1.4% (54/3910), and 1.2% (8/661) of patients in groups A, B, and C, respectively. In the propensity- -adjusted cohort, low HDL-C level increased the risk of primary endpoint (hazard ratio [HR] 1.755, 95% confidence interval [CI] 1.274–2.417, p = 0.001), whereas high HDL-C level did not reduce this risk (HR 0.562, 95% CI 0.275–1.146, p = 0.113). In the propensity-matched cohort, low HDL-C level increased the risk of primary endpoint (HR 1.716, 95% CI 1.210–2.434, p = 0.002), whereas high HDL-C level reduced this risk (HR 0.449, 95% CI 0.214–0.946, p = 0.035).
Conclusions: In AMI patients treated with PCI and statins, low HDL-C level increases the risk of cardiovascular death and recurrent myocardial infarction, whereas high HDL-C level likely reduces the risk of cardiovascular events, especially for ST-elevation myocardial infarction.
Keywords: high-density lipoprotein cholesterolacute myocardial infarctioncardiovascular eventsstatin
References
- Jafri H, Alsheikh-Ali AA, Karas RH. Meta-analysis: statin therapy does not alter the association between low levels of high-density lipoprotein cholesterol and increased cardiovascular risk. Ann Intern Med. 2010; 153(12): 800–808.
- Barter P, Gotto AM, LaRosa JC, et al. Treating to New Targets Investigators. HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events. N Engl J Med. 2007; 357(13): 1301–1310.
- Olsson AG, Schwartz GG, Szarek M, et al. High-density lipoprotein, but not low-density lipoprotein cholesterol levels influence short-term prognosis after acute coronary syndrome: results from the MIRACL trial. Eur Heart J. 2005; 26(9): 890–896.
- Duffy D, Rader DJ. Update on strategies to increase HDL quantity and function. Nat Rev Cardiol. 2009; 6(7): 455–463.
- Acharjee S, Roe MT, Amsterdam EA, et al. Relation of admission high-density lipoprotein cholesterol level and in-hospital mortality in patients with acute non-ST segment elevation myocardial infarction (from the National Cardiovascular Data Registry). Am J Cardiol. 2013; 112(8): 1057–1062.
- Fabregat-Andrés Ó, Ferrando-Beltrán M, Lucas-Inarejos E, et al. High-density lipoproteins and myocardial necrosis in patients with acute myocardial infarction and ST segment elevation. Rev Clin Esp (Barc). 2013; 213(2): 75–80.
- Besler C, Heinrich K, Rohrer L, et al. Mechanisms underlying adverse effects of HDL on eNOS-activating pathways in patients with coronary artery disease. J Clin Invest. 2011; 121(7): 2693–2708.
- Besler C, Lüscher TF, Landmesser U. Molecular mechanisms of vascular effects of High-density lipoprotein: alterations in cardiovascular disease. EMBO Mol Med. 2012; 4(4): 251–268.
- Jeong YAh, Jeong MHo, Jeong HC, et al. Korea Acute Myocardial Infarction Registry (KAMIR) Investigators. Impact of smoking on clinical outcomes in female patients with acute myocardial infarction. Korean Circ J. 2015; 45(1): 22–27.
- Sim DS, Jeong MHo, Cho KH, et al. Other Korea Acute Myocardial Infarction Registry (KAMIR) Investigators. Effect of early statin treatment in patients with cardiogenic shock complicating acute myocardial infarction. Korean Circ J. 2013; 43(2): 100–109.
- National Cholesterol Education Program (NCEP) Expert Panel. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Arch Intern Med. 2002; 6: 284.
- Robins JM, Hernán MA, Brumback B. Marginal structural models and causal inference in epidemiology. Epidemiology. 2000; 11(5): 550–560.
- Xie J, Liu C. Adjusted Kaplan-Meier estimator and log-rank test with inverse probability of treatment weighting for survival data. Stat Med. 2005; 24(20): 3089–3110.
- Wolfram RM, Brewer HB, Xue Z, et al. Impact of low high-density lipoproteins on in-hospital events and one-year clinical outcomes in patients with non-ST-elevation myocardial infarction acute coronary syndrome treated with drug-eluting stent implantation. Am J Cardiol. 2006; 98(6): 711–717.
- Ji MiS, Jeong MHo, Ahn YK, et al. Korea Acute Myocardial Infarction Registry Investigators. Impact of low level of high-density lipoprotein-cholesterol sampled in overnight fasting state on the clinical outcomes in patients with acute myocardial infarction (difference between ST-segment and non-ST-segment-elevation myocardial infarction). J Cardiol. 2015; 65(1): 63–70.
- Khera AV, Cuchel M, de la Llera-Moya M, et al. Cholesterol efflux capacity, high-density lipoprotein function, and atherosclerosis. N Engl J Med. 2011; 364(2): 127–135.
- Sorrentino SA, Besler C, Rohrer L, et al. Endothelial-vasoprotective effects of high-density lipoprotein are impaired in patients with type 2 diabetes mellitus but are improved after extended-release niacin therapy. Circulation. 2010; 121(1): 110–122.
- Angeloni E, Paneni F, Landmesser U, et al. Lack of protective role of HDL-C in patients with coronary artery disease undergoing elective coronary artery bypass grafting. Eur Heart J. 2013; 34(46): 3557–3562.
- Toth PP, Barylski M, Nikolic D, et al. Should low high-density lipoprotein cholesterol (HDL-C) be treated? Best Pract Res Clin Endocrinol Metab. 2014; 28(3): 353–368.
- Barylski M, Toth PP, Nikolic D, et al. Emerging therapies for raising high-density lipoprotein cholesterol (HDL-C) and augmenting HDL particle functionality. Best Pract Res Clin Endocrinol Metab. 2014; 28(3): 453–461.
- Garcia-Rios A, Nikolic D, Perez-Martinez P, et al. LDL and HDL subfractions, dysfunctional HDL: treatment options. Curr Pharm Des. 2014; 20(40): 6249–6255.
- Ryder RE, Hayes TM, Mulligan IP, et al. How soon after myocardial infarction should plasma lipid values be assessed? Br Med J (Clin Res Ed). 1984; 289(6459): 1651–1653.
- Pitt B, Loscalzo J, Ycas J, et al. Lipid levels after acute coronary syndromes. J Am Coll Cardiol. 2008; 51(15): 1440–1445.
- Barth JH, Jackson BM, Farrin AJ, et al. SPACE ROCKET Trial Group. Change in serum lipids after acute coronary syndromes: secondary analysis of SPACE ROCKET study data and a comparative literature review. Clin Chem. 2010; 56(10): 1592–1598.