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Low HDL Cholesterol is Associated with Reduced Bleeding Risk in Patients who Underwent PCI: Findings from the
Ying-Ying Zheng1,2, Ting-Ting Wu1,2, Xian-Geng Hou1
1Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, P.R. China.
Insights
High-density lipoprotein cholesterol (HDL-C) shows a nonlinear relationship with bleeding risk in coronary artery disease (CAD) patients post-percutaneous coronary intervention (PCI). Intermediate HDL-C levels are linked to the highest bleeding risk, while lower levels may offer protection.
Area of Science:
- Cardiology
- Clinical Lipidology
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI) face risks of bleeding and ischemic events.
- The role of high-density lipoprotein cholesterol (HDL-C) in modulating these risks requires further elucidation.
Purpose of the Study:
- To investigate the dose-response relationship between HDL-C levels and the incidence of bleeds in CAD patients after PCI.
- To identify specific HDL-C thresholds associated with altered bleeding risk.
Main Methods:
- Analysis of 15,250 patients from the PRACTICE prospective cohort study.
- Patients stratified into five groups based on HDL-C levels (≤35, 35-45, 45-55, 55-65, >65 mg/dL).
- Comparison of bleed incidence, mortality, ischemic events, and net adverse clinical events (NACEs) across groups, with confounder adjustment.
Main Results:
- A nonlinear association between HDL-C and bleeds was observed, with the highest risk at intermediate levels (45-55 mg/dL).
- A protective effect against bleeds was noted for HDL-C ≤35 mg/dL (adjusted HR 0.560).
- A dose-response relationship for ischemic events was also identified.
Conclusions:
- Intermediate HDL-C levels (45-55 mg/dL) are associated with an increased risk of bleeding in CAD patients post-PCI.
- Low HDL-C (≤35 mg/dL) may be protective against bleeding events.
- Further multicenter studies are recommended to validate these findings.
Background:
We sought to examine the dose-response relationship between high-density lipoprotein cholesterol (HDL-C) and bleeds in coronary artery disease (CAD) patients who underwent percutaneous coronary intervention (PCI).
Methods:
All the 15,250 participants were from the Personalized Antiplatelet Therapy According to CYP2C19 Genotype in Coronary Artery Disease (PRACTICE) study, which is a large, single-center, prospective cohort study based on case records and a follow-up registry performed in the First Affiliated Hospital of Xinjiang Medical University from December 2016 to October 2021. We divided all the patients into five groups according to their HDL-C levels: the ≤35 mg/dL group (n = 4,732), 35 to 45 mg/dL group (n = 6,049), 45 to 55 mg/dL group (n = 2,826), 55 and 65 mg/dL group (n = 1,117), and >65 mg/dL group (n = 526). The incidence of bleeds, mortality, ischemic events, and net adverse clinical events (NACEs) among the five groups was compared.
Results:
A total of 713 bleeds, 1,180 ischemic events, 456 deaths, and 1,893 NACEs were recorded during the up to 60-month follow-up period. After adjusting for confounders, we observed a nonlinear relation for bleeds, with the highest risk at intermediate HDL-C levels (45-55 mg/dL). We also identified a dose-response relationship for ischemic events. A threshold value of HDL-C ≤35 mg/dL (adjusted hazard ratio = 0.560, 95% confidence interval: 0.360-0.872, p = 0.010) was associated with a decreased risk for bleeds in the multivariable Cox regression model. The results were consistent in multiple sensitivity analyses and propensity score-matching analysis.
Conclusion:
In the present study, a nonlinear association was identified between HDL-C levels and bleeds in CAD patients who underwent PCI, with a higher risk at intermediate levels. However, further multicenter studies are warranted.
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