Yashashwi Pokharel1, Yuanyuan Tang2, Bhaskar Bhardwaj3, Krishna K Patel4, Mohammed Qintar4, James H O'Keefe4, Krishnaji R Kulkarni5, Peter H Jones6, Seth S Martin7, Salim S Virani8, John A Spertus4. 1. Department of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA; Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA. Electronic address: pokharely@umkc.edu. 2. Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA. 3. Department of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA; Department of Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA. 4. Department of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA; Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA. 5. VAP Diagnostics Laboratory (formerly Atherotech Diagnostics Lab), Birmingham, AL, USA. 6. Department of Medicine, Baylor College of Medicine, Houston, TX, USA. 7. Department of Medicine, Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD, USA. 8. Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations, Houston, TX, USA.
Abstract
BACKGROUND: Studies of incident coronary heart disease risk within low-density lipoprotein (LDL) subclass (small, dense vs large, buoyant) have shown mixed results. No prospective cohort study has examined the association of small, dense, or large, buoyant LDL with mortality after myocardial infarction (MI). OBJECTIVE: The objective of the study was to examine association of LDL pattern after MI and death. METHODS: In 2476 patients hospitalized for MI, LDL pattern (A [large, buoyant], A/B [mixed], and B [small, dense]) was established by ultracentrifugation using Vertical Auto Profile. Using time-to-event analysis, we examined the association with 5-year mortality within LDL patterns, after adjusting for important patient and treatment characteristics. We additionally adjusted for LDL cholesterol (LDL-C) and triglyceride levels and used directly measured LDL-C and non-high-density lipoprotein cholesterol as exposures. RESULTS: Patterns A, A/B, and B were present in 39%, 28%, and 33% of patients, respectively, with incident rates (per 1000 patient-years) of 50, 34, and 24 for all-cause and 24, 19, and 10 for CV mortality. The hazard ratios (95% confidence interval) with LDL patterns A/B and B compared with pattern A were 0.77 (0.61, 0.99) and 0.67 (0.51, 0.88) for all-cause, 0.94 (0.67, 1.33) and 0.69 (0.46, 1.03) for cardiovascular, and 0.64 (0.45, 0.91) and 0.65 (0.45, 0.93) for noncardiovascular mortalities, respectively. Results were similar when further adjusted for LDL-C and triglycerides, or with LDL-C and non-high-density lipoprotein cholesterol as exposures. CONCLUSION: Compared with LDL pattern A, pattern B was significantly associated with reduced all-cause and non-CV mortalities with a trend for lower CV mortality after MI, independent of LDL-C and triglycerides.
BACKGROUND: Studies of incident coronary heart disease risk within low-density lipoprotein (LDL) subclass (small, dense vs large, buoyant) have shown mixed results. No prospective cohort study has examined the association of small, dense, or large, buoyant LDL with mortality after myocardial infarction (MI). OBJECTIVE: The objective of the study was to examine association of LDL pattern after MI and death. METHODS: In 2476 patients hospitalized for MI, LDL pattern (A [large, buoyant], A/B [mixed], and B [small, dense]) was established by ultracentrifugation using Vertical Auto Profile. Using time-to-event analysis, we examined the association with 5-year mortality within LDL patterns, after adjusting for important patient and treatment characteristics. We additionally adjusted for LDL cholesterol (LDL-C) and triglyceride levels and used directly measured LDL-C and non-high-density lipoprotein cholesterol as exposures. RESULTS: Patterns A, A/B, and B were present in 39%, 28%, and 33% of patients, respectively, with incident rates (per 1000 patient-years) of 50, 34, and 24 for all-cause and 24, 19, and 10 for CV mortality. The hazard ratios (95% confidence interval) with LDL patterns A/B and B compared with pattern A were 0.77 (0.61, 0.99) and 0.67 (0.51, 0.88) for all-cause, 0.94 (0.67, 1.33) and 0.69 (0.46, 1.03) for cardiovascular, and 0.64 (0.45, 0.91) and 0.65 (0.45, 0.93) for noncardiovascular mortalities, respectively. Results were similar when further adjusted for LDL-C and triglycerides, or with LDL-C and non-high-density lipoprotein cholesterol as exposures. CONCLUSION: Compared with LDL pattern A, pattern B was significantly associated with reduced all-cause and non-CV mortalities with a trend for lower CV mortality after MI, independent of LDL-C and triglycerides.
Authors: Suzanne V Arnold; Paul S Chan; Philip G Jones; Carole Decker; Donna M Buchanan; Harlan M Krumholz; P Michael Ho; John A Spertus Journal: Circ Cardiovasc Qual Outcomes Date: 2011-07
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