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A realistic approach to evaluating the effect of baseline lipid profile in postcoronary artery bypass grafting
Ali Sheikhy1,2,3, Aida Fallahzadeh1,2,3, Saeed Sadeghian1
1Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Lipid profiles show nonlinear associations with outcomes after coronary artery bypass grafting (CABG). Extreme levels of LDL-C and HDL-C impact mortality risk differently in men and women post-CABG.
Area of Science:
- Cardiology
- Biochemistry
- Medical Statistics
Background:
- Uncertainties persist regarding lipid profiles and outcomes following coronary artery bypass grafting (CABG).
- Linear models inadequately explain the complex relationship between lipid levels and post-CABG events.
Purpose of the Study:
- To investigate the nonlinear association between lipid profile indices and adverse outcomes after CABG.
- To clarify the impact of lipid levels on mortality and major cerebro-cardiac events (MACCE) post-CABG.
Main Methods:
- Analysis of 17,555 patients undergoing isolated CABG (2005-2016).
- Utilized Restricted Cubic Splines (RCS) with Cox regression, adjusting for confounders.
- Examined nonlinear relationships between lipid profiles and mortality/MACCE over a median 75.24-month follow-up.
Main Results:
- Nonlinear relationships observed between LDL-C, HDL-C, and all-cause mortality.
- Linear association found between remnant cholesterol and all-cause mortality.
- In men, high LDL-C and low HDL-C increased mortality risk; in women, low HDL-C increased risk, while high HDL-C decreased it.
Conclusions:
- Establishing universal cut-offs for lipid profiles post-CABG may be misleading.
- Extreme values (very low or very high) of HDL-C and LDL-C have distinct effects on cardiovascular outcomes.
Background:
There are still many uncertainties in the association between lipid profile and postcoronary artery bypass grafting (CABG) outcomes. Although simplifying the association to linear equations makes it understandable but cannot explain many findings.
Hypothesis:
There is a nonlinear associatin between lipid profile indices and adverse outcomes after CABG.
Methods:
A total of 17 555 patients who underwent isolated CABG between 2005 and 2016 were evaluated. During the median follow-up of 75.24 months, the Restricted Cubic Splines (RCS) estimated from the Cox regression model adjusted for all possible confounders was applied to show a nonlinear relationship of lipid profile contents with the "ln hazard ratio" of mortality and major cerebro-cardiac events (MACCE).
Results:
The relationship between LDL-C and HDL-C with all-cause mortality was nonlinear (nonlinear p were .004 and <.001, respectively). The relationship between remnant cholesterol and all-cause mortality was linear (linearity p = .023). Among men, those in the highest LDL-C level (Q4, LDL-C > 114) and those in the lowest HDL-C level (Q1, HDL-C < 30) showed a significantly higher risk of all-cause mortality compared to other groups (compared with Q3, LDL-C Q4, HR = 1.16, 95% confidence interval [CI]:1.02-1.26, p = .014; HDL-C Q1, HR = 1.14, 95% CI: 1.01-1.31, p = .041). Female patients in the lowest HDL-C level (Q1, HDL-C < 30) showed a significantly higher (compared with Q3, HR = 1.14, 95% CI:1.01-1.31, p = .028) and those in the highest HDL-C level (Q4, HDL-C > 43) showed a significantly lower (compared with Q3, HR = 0.74, 95% CI:0.58-0.98, p = .019) risk of all-cause mortality.
Conclusion:
Determining a universal cut off for components of lipid profile may be misleading and should better be revised. Extreme values (very low or very high) for HDL-C and LDL-C have different effects on cardiovascular outcomes.
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