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[Increased HDL-cholesterol level improves the prognosis in patients with coronary vasospasm]
1Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University.
Insights
Patients with vasospastic coronary artery disease experiencing cardiovascular events had lower high-density lipoprotein cholesterol (HDL-C) levels and were more likely to be smokers. Smoking cessation may be crucial for managing vasospastic angina and preventing adverse cardiovascular events.
Area of Science:
- Cardiology
- Vascular Medicine
- Preventive Cardiology
Context:
- Vasospastic coronary artery disease (CAD) poses a risk for cardiovascular events.
- Diagnostic coronary arteriography is used to confirm coronary artery spasm.
- Long-term follow-up is essential for assessing outcomes in patients with vasospastic CAD.
Purpose:
- To analyze cardiovascular events in patients with vasospastic CAD.
- To identify risk factors associated with cardiovascular events in this patient subset.
- To investigate the role of lipid profiles, particularly high-density lipoprotein cholesterol (HDL-C), and smoking status in cardiovascular outcomes.
Summary:
- A study of 49 patients with vasospastic CAD found that 7 patients experienced cardiovascular accidents (myocardial infarction, unstable angina, stroke) during a 30-month follow-up.
- These events were significantly more common in current smokers (71%) compared to non-smokers (12%).
- While baseline lipid levels, including HDL-C, did not differ, HDL-C levels increased in event-free patients but decreased in those with events. Final HDL-C was significantly lower in the event group.
Impact:
- Current smoking is a significant risk factor for cardiovascular events in vasospastic CAD.
- Declining HDL-C levels during follow-up are associated with adverse cardiovascular events.
- These findings highlight the importance of smoking cessation and monitoring HDL-C levels for managing patients with vasospastic angina.
Abstract:
Cardiovascular events were analyzed in the subset of 49 consecutive patients with vasospastic coronary artery disease who underwent diagnostic coronary arteriography from December, 1987 to March, 1991 to confirm coronary artery spasm during anginal attacks. During the follow-up period (30 +/- 14 months, mean +/- SEM), seven patients had cardiovascular accidents including acute myocardial infarction, unstable angina, and stroke (group A), while the remaining 42 patients were event-free (group B). Current smokers at the end of the follow-up period were more common in group A (71%) than in group B (12%) (p < 0.01). Serum total-cholesterol, low density lipoprotein cholesterol, and triglyceride levels were not significantly different between the two groups before or after the follow-up period. The baseline high-density lipoprotein cholesterol (HDL-C) level also did not differ between group A (32.5 +/- 8.3 mg/dl) and group B (41.0 +/- 12.9 mg/dl). However, the HDL-C level significantly increased during the follow-up period in group B (delta HDL-C 6.1 +/- 9.4 mg/dl) (p < 0.01), but not in group A (delta HDL-C -3.3 +/- 7.2 mg/dl). The HDL-C level at the end of the follow-up period in group A (29.2 +/- 9.0 mg/dl) was significantly lower than in group B (47.1 +/- 11.5 mg/dl) (p < 0.01). Cardiovascular accidents were significantly more common in current smokers (50%) (p < 0.01) than in current nonsmokers (5%) after the follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)