Association between hyperlipidemia and mortality after incident acute myocardial infarction or acute decompensated heart failure: a propensity score matched cohort study and a meta-analysis

Abstract

ObjectiveTo examine the effect of HLP, defined as having a pre-existing or a new in-hospital diagnosis based on low density lipoprotein cholesterol (LDL-C) level ≥100 mg/dL during index hospitalisation or within the preceding 6 months, on all-cause mortality after hospitalisation for acute myocardial infarction (AMI) or acute decompensated heart failure (ADHF) and to determine whether HLP modifies mortality associations of other competing comorbidities. A systematic review and meta-analysis to place the current findings in the context of published literature.DesignRetrospective study, 1:1 propensity-score matching cohorts; a meta-analysis.SettingLarge academic centre, 1996–2015.ParticipantsHospitalised patients with AMI or ADHF.Main outcomes and measuresAll-cause mortality and meta-analysis of relative risks (RR).ResultsUnmatched cohorts: 13 680 patients with AMI (age (mean) 68.5 ± (SD) 13.7 years; 7894 (58%) with HLP) and 9717 patients with ADHF (age, 73.1±13.7 years; 3668 (38%) with HLP). In matched cohorts, the mortality was lower in AMI patients (n=4348 pairs) with HLP versus no HLP, 5.9 versus 8.6/100 person-years of follow-up, respectively (HR 0.76, 95% CI 0.72 to 0.80). A similar mortality reduction occurred in matched ADHF patients (n=2879 pairs) with or without HLP (12.4 vs 16.3 deaths/100 person-years; HR 0.80, 95% CI 0.75 to 0.86). HRs showed modest reductions when HLP occurred concurrently with other comorbidities. Meta-analyses of nine observational studies showed that HLP was associated with a lower mortality at ≥2 years after incident AMI or ADHF (AMI: RR 0.72, 95% CI 0.69 to 0.76; heart failure (HF): RR 0.67, 95% CI 0.55 to 0.81).ConclusionsAmong matched AMI and ADHF cohorts, concurrent HLP, compared with no HLP, was associated with a lower mortality and attenuation of mortality associations with other competing comorbidities. These findings were supported by a systematic review and meta-analysis.

The Association between Nutritional Status and In-Hospital Mortality among Patients with Heart Failure—A Result of the Retrospective Nutritional Status Heart Study 2 (NSHS2)

“…BMI itself is not a good indicator of obesity because it does not consider the exact body composition, i.e., amount of muscle, fat distribution, or water retention. However, due to its ease of use and accessibility, it is an integral part of the physical examination of HF patients [ 27 , 28 ]. However, obesity can lead to an abnormal clinical course [ 29 ].…”

Hyperlipidaemia and mortality among patients hospitalised with pneumonia: retrospective cohort and propensity score matched study

“… 44 In propensity score matched cohort studies and systematic review and meta-analysis, we reported a survival benefit with HLP after hospitalisation for acute myocardial infarction and heart failure. 24 25 In an analysis of initial and subsequent 3-year cost after hospitalisation for first-ever ischaemic stroke, we also reported that HLP predicts a lower 3-year cost mainly through a reduction in rates of readmission after index hospitalisation. 45 …”

“…52 Current findings in pneumonia together with our previous studies focused on patients with acute myocardial infarction and heart failure provide persuasive evidence for a more favourable effect of HLP, compared with no HLP, on long-term clinical outcomes in diverse clinical conditions. 24 25 …”

“…Details about ascertainment of HLP have been described in our previous publications. 24 25 In brief, HLP was defined as provider-documented pre-existing diagnosis or a new in-hospital diagnosis based on LDL-C level ≥100 mg/dL during index hospitalisation or within the preceding 6 months. Similarly, the diagnosis of 'no hyperlipidaemia' was assigned to those with no provider documentation of pre-existing HLP on admission.…”

Predicting One-Year Deaths and Major Adverse Vascular Events with the Controlling Nutritional Status Score in Elderly Patients with Non–ST-Elevated Myocardial Infarction Undergoing Percutaneous Coronary Intervention

“…When both groups were evaluated using the other two scoring systems based on malnutrition, malnourished patients had statistically lower PNI (42.8 ± 3.8 vs. 49.7 ± 5.4 points; p < 0.01) and GNRI (94.7 ± 4.6 vs. 99.3 ± 4.6 points; p < 0.01) scores. Malnourished individuals also had higher anatomical SSI (15 (11-24) vs. 10.0 (7-15) points; p < 0.01) and higher SSII-PCI (34 (28-43) vs. 27 (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) points; p < 0.01) points than the non-malnourished patients. Detailed demographic, clinical parameters and laboratory and angiographic parameters of all study participants and as compared between the two groups are included in Tables 2 and 3.…”