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High-density lipoprotein subclass profile and mortality in patients with coronary artery disease: Results from the
Meyer Elbaz1, Julien Faccini2, Vanina Bongard3
1Inserm UMR-1048, Institute of Metabolic and Cardiovascular Diseases, 1, avenue Jean-Poulhès, 31432 Toulouse, France; Toulouse University Paul-Sabatier, 31062 Toulouse, France; Department of Cardiology, CHU de Toulouse, 31432 Toulouse, France.
Insights
High-density lipoprotein (HDL) subclasses do not predict mortality in coronary artery disease (CAD) patients. Other factors like heart rate and ejection fraction are more significant predictors of outcomes in CAD.
Area of Science:
- Cardiovascular Medicine
- Lipidology
- Clinical Chemistry
Background:
- High-density lipoproteins (HDLs) are heterogeneous, with subclass contributions to coronary artery disease (CAD) outcomes debated.
- Current understanding of HDL subclass impact on clinical prognosis in CAD is limited.
Purpose of the Study:
- To investigate the association between HDL subclass profiles and mortality risk in patients with established CAD.
- To utilize a novel electrophoretic method for quantitative assessment of HDL particle size phenotypes.
Main Methods:
- A cohort of 403 CAD patients underwent cardiovascular evaluation.
- HDL subclass distribution was analyzed using the Quantimetrix Lipoprint® HDL system.
- Kaplan-Meier and Cox proportional hazards regression analyses assessed survival and risk factors.
Main Results:
- Mortality rate was 31.0% over 9.8 years, with 60.8% of deaths CAD-related.
- No significant differences in total HDL cholesterol or small, intermediate, and large HDL subclasses were found between deceased and alive patients.
- Heart rate, left ventricular ejection fraction, and coronary atherosclerosis severity were stronger predictors of mortality than HDL subclasses or total HDL cholesterol.
Conclusions:
- The HDL subclass profile does not appear to be associated with mortality in patients with CAD.
- Further research is needed to explore the role of HDL subclasses in predicting residual cardiovascular risk.
Background:
High-density lipoproteins (HDLs) are highly heterogeneous particles, and the specific contribution of each subclass to the prediction of clinical outcome in coronary artery disease (CAD) remains controversial.
Objective:
To examine the relationship between HDL subclass profile and mortality in patients with CAD, using a new and rapid electrophoretic quantitative method for the assessment of HDL particle size phenotype.
Methods:
We investigated 403 patients with CAD admitted for cardiovascular examination in the context of evaluation and management of CAD. HDL subclass distribution was analysed using the Quantimetrix Lipoprint® HDL system. Cumulative survival of patients according to lipid variables was determined by the Kaplan-Meier method. The relationship between baseline variables and outcome criteria was assessed using Cox proportional hazards regression analysis.
Results:
During follow-up (9.8±3.1 years) the mortality rate was 31.0%; 60.8% of deaths were related to CAD. The concentration of total HDL cholesterol was similar in deceased patients (42±13mg/dL) and alive patients (43±12mg/dL); the concentrations of small, intermediate and large HDL cholesterol subclasses were not significantly different in alive and deceased patients (P=0.17, P=0.34 and P=0.81, respectively). We did not observe any independent associations between overall or cardiovascular mortality and total HDL cholesterol or any HDL subclass. However, heart rate, left ventricular ejection fraction and severity score for coronary atherosclerosis were more associated with mortality than classical cardiovascular risk factors.
Conclusions:
HDL subclass profile is not associated with mortality in patients with CAD. Further investigations linking HDL subclass repartition with prediction of residual cardiovascular risk are required.
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