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Published on: January 28, 2020
Predictive values of novel high‑density lipoprotein‑related inflammatory indices in in‑stent restenosis among
Xuantong Guo1, Ruihuan Shen2, Peipei Lu1
1State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R. China.
Insights
High-density lipoprotein (HDL)-related inflammatory indices, such as the white blood cell-to-HDL ratio (WHR), are linked to an increased risk of in-stent restenosis (ISR) after percutaneous coronary intervention (PCI). These markers may predict ISR development in patients undergoing PCI.
Area of Science:
- Cardiology
- Biochemistry
- Inflammation Research
Background:
- In-stent restenosis (ISR) is a significant complication following percutaneous coronary intervention (PCI), often linked to inflammation and lipid metabolism disorders.
- High-density lipoprotein (HDL) plays a crucial role in lipid metabolism and possesses anti-inflammatory properties, suggesting its involvement in ISR pathogenesis.
Purpose of the Study:
- To investigate the association between HDL-related inflammatory indices and the risk of developing ISR in patients undergoing elective PCI.
- To determine if indices like the white blood cell-to-HDL ratio (WHR), lymphocyte-to-HDL ratio (LHR), and neutrophil-to-HDL ratio (NHR) can predict ISR risk.
Main Methods:
- Retrospective analysis of 1,471 patients undergoing elective PCI.
- Classification of patients into tertiles based on HDL-related inflammatory indices.
- Multivariable Cox proportional hazards regression and restricted cubic splines (RCS) analysis to assess associations with ISR over a median follow-up of 62.27 months.
Main Results:
- ISR developed in 17.06% of patients during follow-up.
- Higher tertiles of WHR were significantly associated with an increased risk of ISR in a non-linear, dose-dependent manner.
- Elevated LHR and NHR were also positively associated with ISR risk, with the highest tertiles showing a 41.2% and 44.7% increased risk, respectively.
Conclusions:
- Lipid metabolism and inflammation are interconnected in ISR development.
- HDL-related inflammatory indices, including WHR, LHR, and NHR, show potential as predictive markers for ISR prognosis after elective PCI.
Abstract:
Inflammation and disorders in lipid metabolism play pivotal roles in the development and progression of in-stent restenosis (ISR). The present study aimed to investigate the association between the high-density lipoprotein (HDL)-related inflammatory indices and the risk of developing ISR among patients undergoing elective percutaneous coronary intervention (PCI). A sum of 1,471 patients undergoing elective PCI were retrospectively included and classified by tertiles of HDL-related inflammatory indices. The study endpoint was ISR. The multivariable Cox proportional hazards regression analysis with restricted cubic splines (RCS) was used to assess the associations. During a median follow-up of 62.27 months, 251 (17.06%) patients experienced ISR. The incidence of ISR increased with the increasing white blood cell-to-HDL ratio (WHR) tertiles (log-rank test, overall P=0.0082). After full adjustment, the highest tertile of WHR was significantly associated with a 1.603-fold risk of ISR (hazard ratio, 1.603; 95% confidence interval, 1.152-2.231; P=0.005) in contrast to the lowest tertile of the WHR. Results of RCS further indicated that the association between WHR and ISR was in a non-linear and dose-dependent manner (non-linear P=0.034; P overall=0.019). The lymphocyte-to-HDL ratio (LHR) and neutrophil-to-HDL ratio (NHR) were also significantly and positively associated with the risk of ISR, of which the third tertiles were at increased risk of 41.2 and 44.7% after full adjustment, respectively. Overall, lipid metabolism disorders and inflammation were interconnected in the development of ISR; therefore, HDL-related inflammatory indices, including WHR, LHR and NHR, might be potential predictors in the prognosis of elective PCI.
