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Admission LDL-C and long-term mortality in patients with acute aortic dissection: a survival analysis in China
Xin Zeng1, Xuan Zhou2, Xue-Rui Tan3
1Department of Geriatrics, The First Affiliated Hospital of Shantou University Medical College, Shantou, China.
Insights
Lowering serum low-density lipoprotein cholesterol (LDL-C) in acute aortic dissection (AAD) patients may increase long-term mortality risk. This study found lower admission LDL-C levels are linked to worse outcomes in AAD survivors.
Area of Science:
- Cardiology
- Vascular Surgery
- Biochemistry
Background:
- Blood lipid levels significantly impact cardiovascular disease prognosis.
- Acute aortic dissection (AAD) is a critical condition requiring careful prognostic evaluation.
- The relationship between serum low-density lipoprotein cholesterol (LDL-C) and long-term outcomes in AAD patients warrants investigation.
Purpose of the Study:
- To investigate the association between admission serum LDL-C levels and long-term mortality in patients diagnosed with AAD.
- To determine if lower LDL-C levels predict increased mortality risk in AAD.
Main Methods:
- Retrospective analysis of 284 AAD patients from February 2016 to September 2019.
- Patients were stratified into low-level (<2.755 mmol/L) and high-level (≥2.755 mmol/L) LDL-C groups based on ROC curve analysis.
- Kaplan-Meier survival analysis and multivariate Cox regression were employed to assess long-term mortality.
Main Results:
- The optimal cut-off for LDL-C was determined to be 2.755 mmol/L.
- Patients in the lower LDL-C group (<2.755 mmol/L) exhibited significantly higher long-term mortality (P<0.001).
- Multivariate analysis confirmed that LDL-C <2.755 mmol/L was an independent predictor of increased AAD mortality (HR=3.287, P=0.001). Cystatin C also emerged as a risk factor.
Conclusions:
- Lower admission serum LDL-C levels are associated with an increased risk of long-term mortality in patients with AAD.
- These findings suggest a potential paradox where lower LDL-C may indicate a poorer prognosis in AAD.
Background:
The level of blood lipid is closely related to prognosis in cardiovascular diseases. This study aims to analyze the effect of serum low-density lipoprotein cholesterol (LDL-C) levels on the long-term mortality in acute aortic dissection (AAD). A lower admission LDL-C level is associated with an increased risk of long-term mortality in AAD.
Methods:
We analyzed the data of 284 patients with AAD admitted to the First Affiliated Hospital of Shantou University Medical College from February 2016 to September 2019. Patients were followed up post-discharge. All patients were divided into either an LDL-C low-level group or an LDL-C high-level group according to the optimal cut-off point obtained by the receiver operating characteristic (ROC) curve. The endpoint outcome was long-term mortality in AAD. A survival analysis and Cox proportional hazards model were used.
Results:
According to the Youden index, the optimal cut-off point for LDL-C was 2.755 mmol/L. The Kaplan-Meier survival analysis curves showed that the long-term mortality of the LDL-C low-level group (<2.755 mmol/L) was significantly higher than that of the LDL-C high-level group (≥2.755 mmol/L) (log-rank χ2=13.912, P<0.001). After multivariate Cox regression analysis, LDL-C <2.755 mmol/L was still significantly associated with long-term mortality in AAD (HR=3.287, 95% CI: 1.637-6.600, P=0.001). In addition, cystatin C was also an independent risk factor for the long-term prognosis of AAD (HR=1.253, 95% CI: 1.057-1.486, P=0.009).
Conclusions:
A lower admission LDL-C level may be associated with an increased risk of long-term mortality in AAD.
