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Sex-based association between high-density lipoprotein cholesterol and adverse outcomes after coronary artery bypass
Sara Montazeri Namin1,2, Ali Moradi1, Hamed Tavolinejad3
1Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Insights
High-density lipoprotein cholesterol (HDL-C) did not significantly impact mortality or major adverse cardiovascular and cerebrovascular events (MACCE) after coronary artery bypass graft (CABG) surgery. However, HDL-C showed a more protective effect in males than females.
Area of Science:
- Cardiovascular Medicine
- Biochemistry
- Surgical Outcomes Research
Background:
- High-density lipoprotein cholesterol (HDL-C) is a known protective factor against coronary artery diseases (CAD).
- Limited research exists on the association between HDL-C levels and outcomes following coronary artery bypass graft (CABG) surgery.
Purpose of the Study:
- To investigate the association between pre-operative HDL-C levels and one-year post-CABG outcomes.
- To explore potential sex-based differences in this association.
Main Methods:
- A registry-based study of 17,772 patients undergoing elective isolated CABG (2007-2017).
- Patients were categorized into low and desirable HDL-C groups.
- Cox proportional hazard models and Inverse Probability Weighting (IPW) were used to analyze mortality and major adverse cardiovascular and cerebrovascular events (MACCE), with subgroup analysis by sex.
Main Results:
- No significant difference in mortality or MACCE was observed between low and desirable HDL-C groups after IPW adjustment.
- Sex-based subgroup analysis revealed no significant association.
- A significant interaction was found between HDL-C levels, sex, and cardiovascular outcomes (HR=1.19, p=0.030).
Conclusions:
- Pre-operative HDL-C levels were not associated with one-year mortality or MACCE post-CABG.
- HDL-C demonstrated a significantly more protective effect against adverse outcomes in males compared to females.
- Further research is needed to understand the underlying mechanisms of this sex-specific association.
Background:
High-density lipoprotein cholesterol (HDL-C) is shown to be an independent protective factor against coronary artery diseases (CAD). Yet there are limited studies focusing on the association between HDL-C and coronary artery bypass graft (CABG) surgery outcomes.
Hypothesis:
Low levels of HDL-C are associated with higher incidence of adverse outcomes in patients undergoing CABG.
Methods:
This registry-based study included 17,772 patients who underwent elective isolated CABG between 2007 and 2017. Patients were classified into low and desirable HDL-C groups based on their serum HDL-C levels at admission and were followed for one-year post-surgery. The study population included 13,321 patients with low HDL-C and 4,451 with desirable HDL-C. proportional hazard Cox models were performed to evaluate the association between HDL-C levels and incidence of mortality as well as major adverse cardiovascular and cerebrovascular events (MACCE), while adjusting for potential confounders. Moreover, participants were stratified based on sex and the association was also investigated in each subgroup separately.
Results:
No significant difference was found between the groups regarding incidence of both mortality and MACCE, after adjusting with Inverse Probability Weighting (IPW) [HR (95%CI): 0.84 (0.46-1.53), p-value:0.575 and HR (95% CI): 0.91 (0.56-1.50), p-value:0.733, respectively]. According to the sex-based subgroup analysis, no significant association was observed after adjustment with IPW analysis. However, as we examined the association between the interaction of HDL-C levels, sex and cardiovascular outcomes, we found a significant association (HR;1.19 (95%CI: 1.04-1.45); p = 0.030).
Conclusion:
HDL-C level was not associated with either mortality or MACCE during one year after CABG procedure. Sex-based analysis showed that in males, HDL-C is significantly more protective against these outcomes, compared to females. Further studies are necessary to elucidate the exact mechanisms mediating such association.
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