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A V-shaped association between high-density lipoprotein cholesterol levels and poor outcomes in patients after
Xiao-Fang Chen1, Yi-Fei Xiang1, Xiao-Ling Cai1
1Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China; Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases, Fuzhou, China.
Insights
High density lipoprotein cholesterol (HDL-C) levels show a V-shaped risk for poor outcomes after percutaneous coronary intervention (PCI). Both very low and very high HDL-C are linked to increased mortality, suggesting an optimal range for better prognosis.
Area of Science:
- Cardiovascular Medicine
- Clinical Lipidology
- Interventional Cardiology
Background:
- High-density lipoprotein cholesterol (HDL-C) is traditionally viewed as "good cholesterol".
- Emerging evidence indicates that elevated HDL-C may be associated with adverse outcomes in specific patient groups.
- Understanding the role of HDL-C in post-procedural cardiovascular health is crucial.
Purpose of the Study:
- To examine the relationship between HDL-C concentrations and adverse outcomes in patients following percutaneous coronary intervention (PCI).
- To identify potential optimal HDL-C ranges for patients undergoing PCI.
Main Methods:
- A cohort of patients undergoing PCI between January 2012 and December 2018 was analyzed.
- Patients were stratified into three groups based on HDL-C levels: ≤25 mg/dL, 25-60 mg/dL, and >60 mg/dL.
- All-cause mortality (ACM) and cardiovascular mortality (CM) were assessed using multivariable Cox regression analysis, with restricted cubic spline analysis employed to evaluate the HDL-C association.
Main Results:
- The study followed 7284 participants for a median of 4 years, recording 727 all-cause deaths and 334 cardiovascular deaths.
- A V-shaped association was observed between HDL-C levels and patient prognosis.
- Both excessively low (HDL-C ≤25 mg/dL) and high (HDL-C >60 mg/dL) HDL-C levels were independently associated with significantly increased risks of ACM and CM compared to midrange HDL-C levels (25 < HDL-C ≤60 mg/dL).
Conclusions:
- HDL-C levels exhibit a V-shaped association with poor outcomes in patients post-PCI.
- Both very low and very high HDL-C levels are linked to increased all-cause and cardiovascular mortality.
- An optimal HDL-C range of 25-60 mg/dL appears to be associated with the lowest mortality risk in this population.
Background:
High density lipoprotein cholesterol (HDL-C) is considered as "good cholesterol". Recent evidence suggests that a high HDL-C level may increase the risk of poor outcomes in some populations.
Purpose:
To investigate the association between HDL-C levels and poor outcomes in patients after percutaneous coronary intervention (PCI).
Methods:
Patients undergoing PCI during January 2012 and December 2018 were consecutively recruited and divided into three groups with different HDL-C levels: HDL-C ≤ 25 mg/dL, 25 < HDL-C ≤ 60 mg/dL, HDL-C > 60 mg/dL by the restricted cubic spline (RCS) analysis and assessed for all-cause mortality (ACM). The association between HDL-C levels and poor outcomes was assessed by multivariable cox regression analysis.
Results:
The patients were followed with a median duration of 4 years. Of the 7284 participants, 727 all-cause deaths and 334 cardiovascular deaths occurred. A V-shaped association of HDL-C with the prognosis was observed, patients with either excessively low or high HDL-C levels reporting a higher risk than those with midrange values. After adjustment for confounding factors, the former exhibited a higher cumulative rate of ACM and cardiovascular mortality (CM) than the latter [low HDL-C: for ACM, hazard ratio (HR), 1.96; 95%CI, 1.41, 2.73, P < 0.001; for CM, HR, 1.66; 95%CI, 1.03, 2.67; P = 0.037; high HDL-C: for ACM, HR, 1.73; 95%CI, 1.29, 2.32, P < 0.001; for CM, HR, 1.73; 95%CI, 1.16, 2.58; P = 0.007].
Conclusion:
HDL-C levels display a V-shaped association with poor outcomes in patients after PCI, with excessively high or low HDL-C suggesting a higher mortality risk. An optimal HDL-C level may fall in the range of 25-60 mg/dL.
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