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High-density lipoprotein cholesterol, coronary artery disease, and cardiovascular mortality

Guenther Silbernagel1, Ben Schöttker, Sebastian Appelbaum

  • 1Department of Angiology, Swiss Cardiovascular Center, Inselspital, University of Bern, Bern, Switzerland.

European Heart Journal
|September 10, 2013
PubMed

Insights

High-density lipoprotein (HDL) cholesterol predicts cardiovascular mortality, but its predictive power diminishes in individuals with coronary artery disease (CAD). Risk stratification using HDL cholesterol may be less effective for CAD patients.

Area of Science:

  • Cardiology
  • Biomarkers
  • Public Health

Background:

  • High-density lipoprotein (HDL) cholesterol is a key indicator of cardiovascular mortality risk.
  • The predictive value of HDL cholesterol in the context of existing coronary artery disease (CAD) requires further investigation.

Purpose of the Study:

  • To determine if the presence of coronary artery disease (CAD) affects the predictive capability of high-density lipoprotein (HDL) cholesterol for cardiovascular mortality.
  • To assess the utility of HDL cholesterol in cardiovascular risk stratification among patients with and without CAD.

Main Methods:

  • Analysis of 3141 participants from the LURIC study, categorized by CAD status (none, stable, unstable).
  • Prospective follow-up for cardiovascular mortality over a median of 9.9 years.
  • Replication of findings in AtheroGene and ESTHER cohorts, followed by a meta-analysis.

Main Results:

  • HDL cholesterol showed an inverse relationship with cardiovascular mortality in the overall cohort (P = 0.009).
  • A significant interaction between HDL cholesterol and CAD was observed (P = 0.007).
  • HDL cholesterol strongly predicted mortality in non-CAD individuals but not in stable or unstable CAD patients.

Conclusions:

  • The inverse association between HDL cholesterol and cardiovascular mortality is attenuated in patients with CAD.
  • The clinical utility of HDL cholesterol for cardiovascular risk stratification appears limited in individuals with established CAD.
Abstract

Keywords:
AtherosclerosisCardiovascular mortalityHigh-density lipoprotein cholesterol

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