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Patterns and prognostic implications of low high-density lipoprotein levels in patients with non-ST-segment elevation
Matthew T Roe1, Fang-Shu Ou, Karen P Alexander
1Department of Medicine, Division of Cardiovascular Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27705, USA. matthew.roe@duke.edu
Insights
Nearly one-fifth of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) have very low high-density lipoprotein (HDL) levels. This finding indicates increased atherosclerosis and higher mortality risk in these patients.
Area of Science:
- Cardiology
- Lipid Metabolism
- Acute Coronary Syndromes
Background:
- Low high-density lipoprotein (HDL) cholesterol patterns and prognostic significance are not well-defined.
- Understanding these factors in non-ST-segment elevation acute coronary syndromes (NSTE ACS) is crucial.
Purpose of the Study:
- To determine the prevalence of low HDL cholesterol levels in NSTE ACS patients.
- To assess the prognostic significance of these low HDL levels.
Main Methods:
- Analysis of HDL levels in 93,263 NSTE ACS patients from the CRUSADE initiative (2001-2006).
- Categorization of HDL levels: very low (10-29 mg/dL), low (30-39 mg/dL), normal (40-59 mg/dL), and high (60-100 mg/dL).
- Evaluation of clinical, angiographic, and in-hospital outcomes based on HDL categories.
Main Results:
- 18.1% of patients had very low HDL levels; 34.5% had low HDL levels.
- Patients with very low HDL were younger, more male, obese, and diabetic.
- Very low HDL was associated with multi-vessel coronary disease and higher in-hospital mortality.
Conclusions:
- Very low HDL levels are prevalent in nearly one-fifth of NSTE ACS patients.
- This finding suggests a greater atherosclerotic burden and increased mortality risk.
- Further research into strategies to mitigate adverse outcomes in these patients is warranted.
Aims:
The patterns and prognostic significance of low high-density lipoprotein (HDL) cholesterol levels have not been well characterized. We sought to determine the prevalence and prognostic significance of low HDL cholesterol levels in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS).
Methods And Results:
We evaluated HDL levels among NSTE ACS patients [ischaemic ECG (electrocardiogram) changes and/or positive cardiac markers] from the CRUSADE [Can Rapid Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC(American College of Cardiology)/AHA(American Heart Association) Guidelines] initiative treated at 555 US hospitals from January 2001 through June 2006. Clinical and angiographic characteristics, treatments, and in-hospital outcomes were analysed by categories of HDL levels measured during hospitalization. Among 93 263 NSTE ACS patients with HDL measurements, 16 854 (18.1%) had very low HDL levels (10-29 mg/dL), 32 185 (34.5%) had low HDL levels (30-39 mg/dL), 35 875 (38.5%) had normal HDL levels (40-59 mg/dL), and 8349 (9.0%) had high HDL levels (60-100 mg/dL). Patients with very low HDL levels were younger, more often male, and more commonly obese and diabetic. Patients with very low HDL levels had the greatest risk of multi-vessel coronary disease on angiography and in-hospital mortality compared with patients with normal and high HDL levels.
Conclusion:
Almost one-fifth of patients with NSTE ACS have very low HDL levels--a finding that adds incrementally to a greater burden of atherosclerosis and a higher risk of mortality. Consequently, strategies for mitigating the adverse prognosis associated with very low HDL levels warrant further exploration in patients with ACS.
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