AIMS: Primary prevention studies have confirmed that high-density lipoprotein cholesterol (HDL-C) levels are strongly associated with reduced cardiovascular events. However, recent evidence suggests that HDL-C functionality may be impaired under certain conditions. In the present study, we hypothesize that HDL-C may lose their protective role in the secondary prevention of coronary artery disease (CAD). METHODS AND RESULTS: A consecutive series of 1548 patients undergoing isolated first-time elective CABG at one institution between 2004 and 2009 was studied. According to the ATPIII criteria, pre-operative HDL-C values were used to identify patients with high (Group A) vs. low HDL-C (Group B). To eliminate biased estimates, a propensity score model was built and two cohorts of 1:1 optimally matched patients were obtained. Cumulative survival and major adverse cardiovascular events (MACE) were analysed by means of Kaplan-Meier method. Cox proportional-hazards regression models were used to identify independent predictors of MACE and death. Propensity matching identified two cohorts of 502 patients each. At a median follow-up time of 32 months, there were 44 out of 502 (8.8%) deaths in Group A and 36 out of 502 deaths in Group B (7.2%, HR 1.19; P = 0.42). MACE occurred in 165 out of 502 (32.9%) in Group A and 120 out of 502 (23.9%) in Group B (P = 0.04). Regression analysis showed that pre-operative HDL-C levels were not associated with reduced but rather increased MACE occurrence during follow-up (HR 1.43, P = 0.11). CONCLUSION: Higher HDL-C levels are not associated with reduced risk of vascular events in CAD patients undergoing CABG. Our findings may support efforts to improve HDL-C functionality instead of increasing their levels.
AIMS: Primary prevention studies have confirmed that high-density lipoprotein cholesterol (HDL-C) levels are strongly associated with reduced cardiovascular events. However, recent evidence suggests that HDL-C functionality may be impaired under certain conditions. In the present study, we hypothesize that HDL-C may lose their protective role in the secondary prevention of coronary artery disease (CAD). METHODS AND RESULTS: A consecutive series of 1548 patients undergoing isolated first-time elective CABG at one institution between 2004 and 2009 was studied. According to the ATPIII criteria, pre-operative HDL-C values were used to identify patients with high (Group A) vs. low HDL-C (Group B). To eliminate biased estimates, a propensity score model was built and two cohorts of 1:1 optimally matched patients were obtained. Cumulative survival and major adverse cardiovascular events (MACE) were analysed by means of Kaplan-Meier method. Cox proportional-hazards regression models were used to identify independent predictors of MACE and death. Propensity matching identified two cohorts of 502 patients each. At a median follow-up time of 32 months, there were 44 out of 502 (8.8%) deaths in Group A and 36 out of 502 deaths in Group B (7.2%, HR 1.19; P = 0.42). MACE occurred in 165 out of 502 (32.9%) in Group A and 120 out of 502 (23.9%) in Group B (P = 0.04). Regression analysis showed that pre-operative HDL-C levels were not associated with reduced but rather increased MACE occurrence during follow-up (HR 1.43, P = 0.11). CONCLUSION: Higher HDL-C levels are not associated with reduced risk of vascular events in CAD patients undergoing CABG. Our findings may support efforts to improve HDL-C functionality instead of increasing their levels.
Authors: Seth S Martin; Arif A Khokhar; Heidi T May; Krishnaji R Kulkarni; Michael J Blaha; Parag H Joshi; Peter P Toth; Joseph B Muhlestein; Jeffrey L Anderson; Stacey Knight; Yan Li; John A Spertus; Steven R Jones Journal: Eur Heart J Date: 2014-06-30 Impact factor: 29.983
Authors: Jin Sup Park; Kwang Soo Cha; Hye Won Lee; Jun-Hyok Oh; Jung Hyun Choi; Han Cheol Lee; Taek Jong Hong; Myung Ho Jeong; Shung Chull Chae; Young Jo Kim Journal: Cardiol J Date: 2018-03-07 Impact factor: 2.737
Authors: Jean-Charles Fruchart; Jean Davignon; Michel P Hermans; Khalid Al-Rubeaan; Pierre Amarenco; Gerd Assmann; Philip Barter; John Betteridge; Eric Bruckert; Ada Cuevas; Michel Farnier; Ele Ferrannini; Paola Fioretto; Jacques Genest; Henry N Ginsberg; Antonio M Gotto; Dayi Hu; Takashi Kadowaki; Tatsuhiko Kodama; Michel Krempf; Yuji Matsuzawa; Jesús Millán Núñez-Cortés; Carlos Calvo Monfil; Hisao Ogawa; Jorge Plutzky; Daniel J Rader; Shaukat Sadikot; Raul D Santos; Evgeny Shlyakhto; Piyamitr Sritara; Rody Sy; Alan Tall; Chee Eng Tan; Lale Tokgözoğlu; Peter P Toth; Paul Valensi; Christoph Wanner; Alberto Zambon; Junren Zhu; Paul Zimmet Journal: Cardiovasc Diabetol Date: 2014-01-24 Impact factor: 9.951