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The Effect of High-Density Lipoprotein on the Rheumatic Mitral Valve Calcification and Surgical Prognosis

Peiyi Liu1, Songhao Jia1, Tingting Liu2

  • 1Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Lab for Cardiovascular Precision Medicine, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China.

JACC. Asia
|November 7, 2025
PubMed

Insights

Higher high-density lipoprotein (HDL) levels in patients undergoing rheumatic heart disease surgery are linked to reduced valve calcification and better survival outcomes. This finding highlights HDL

Area of Science:

  • Cardiovascular Medicine
  • Rheumatology
  • Biochemistry

Background:

  • Rheumatic heart disease (RHD) is a significant cause of valvular heart disease in Asia, frequently leading to severe valve calcification.
  • The underlying mechanisms of RHD-related valve calcification and their impact on surgical outcomes remain incompletely understood.

Purpose of the Study:

  • To investigate the association between preoperative plasma high-density lipoprotein (HDL) levels and the development of mitral valve calcification in RHD patients.
  • To evaluate the influence of HDL levels on the mid-term prognosis and major adverse cardiovascular events (MACE) following mitral valve surgery for RHD.

Main Methods:

  • Retrospective cohort study of 847 patients with RHD who underwent mitral valve surgery between January 2016 and December 2022.
  • Patients were stratified into high HDL (n=413) and low HDL (n=434) groups based on preoperative HDL cholesterol levels.
  • Kaplan-Meier analysis, multivariate Cox regression, and logistic regression were employed to assess survival, MACE, and calcification risk.

Main Results:

  • The high HDL group exhibited significantly higher mid-term survival rates (P=0.018) and a lower risk of MACE (P=0.005) compared to the low HDL group.
  • Preoperative HDL levels were identified as an independent protective factor against MACE (HR: 0.370; P < 0.001) and mitral valve calcification (HR: 0.01; P=0.009).
  • Lower Agatston scores for calcification were observed with increasing HDL levels, particularly below 1.3 mmol/L (P for nonlinear=0.05).

Conclusions:

  • Elevated preoperative HDL levels are associated with reduced mitral valve calcification in RHD patients.
  • Higher HDL levels correlate with improved mid-term survival and a decreased risk of major adverse cardiovascular events after valve surgery.
  • HDL cholesterol may play a protective role in the pathophysiology of RHD-related valve calcification and surgical outcomes.
Abstract

Keywords:
high-density lipoproteinmitral valve calcificationrheumatic heart valve diseasesurgical prognosis

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