High-density lipoprotein cholesterol as a predictor of clinical outcomes in patients achieving low-density lipoprotein cholesterol targets with statins after percutaneous coronary intervention

Abstract

BackgroundA low level of high-density lipoprotein cholesterol (HDL-C) is strongly associated with cardiovascular events. However, the significance of HDL-C after statin therapy on the outcome of patients who have undergone percutaneous coronary intervention (PCI) with drug eluting stents (DES) is unclear.ObjectivesTo investigate the significance of HDL-C after statin therapy on cardiovascular events in patients with coronary artery disease after DES implantation.MethodsPatients who underwent PCI with DES from January 2004 to December 2009 were prospectively enrolled. The follow-up lipid panel of 2693 patients (median lab follow-up duration 225 days) who had continued using statins after PCI and who attained low-density lipoprotein cholesterol (LDL-C) <100 mg/dl was analysed. Major adverse cardiac events (MACE), including all-cause death, non-fatal myocardial infarction, and target vessel revascularisation according to follow-up HDL-C level (40 mg/dl for men or 50 mg/dl for women) were compared with the use of propensity scores matching.ResultsMedian follow-up duration was 832 days. 1585 (58.9%) patients had low follow-up HDL-C and 1108 had high follow-up HDL-C. The low follow-up HDL-C group had significantly higher rates of MACE. Low follow-up HDL-C was a significant independent predictor of MACE (adjusted HR 1.404, 95% CI 1.111 to 1.774, p=0.004). In further analysis with propensity scores matching, overall findings were consistent.ConclusionsRaising HDL-C levels may be a subsequent goal after achieving target LDL-C levels in patients with DES implantation.

Secondary Prevention After Coronary Artery Bypass Graft Surgery

“…[143][144][145][146][147] Frequently seen in patients with CAD, a low HDL level has been well described as an independent risk factor for adverse cardiovascular outcomes in several studies. 142,[148][149][150][151][152] Some of the earliest data on the subject became available from the Framingham Heart Study, in which low HDL was found to be a more potent CAD risk factor than high LDL. 148,150 Recent studies from the current era have shown that HDL levels are inversely related to cardiovascular events, even among patients receiving statin therapy 152 and those with LDL levels aggressively treated to <70 mg/dL.…”

“…142,[148][149][150][151][152] Some of the earliest data on the subject became available from the Framingham Heart Study, in which low HDL was found to be a more potent CAD risk factor than high LDL. 148,150 Recent studies from the current era have shown that HDL levels are inversely related to cardiovascular events, even among patients receiving statin therapy 152 and those with LDL levels aggressively treated to <70 mg/dL. 151 In addition, moderate increases in HDL appear to be associated with regression of coronary atherosclerosis in statin-treated patients.…”

High Density Lipoprotein Cholesterol in Coronary Artery Disease: When Higher Means Later

“…The entire patient population was divided into always lower at higher levels of achieved HDL-C 6) . The protective effect of high vs low HDL-C has also been demonstrated in patients achieving LDL-C targets with statins after percutaneous coronary interventions 7) . Very recently, HDL-C levels have been shown to be most closely associated with the presence of CAD assessed by multi-detector row computed tomography, irrespective of statin treatment 8) .…”

Effect of Hemodialysis on 7-Year Clinical Outcomes After Sirolimus-Eluting Stent Implantation

“…Moreover, low HDL-cholesterol levels have been reported as predictive of negative clinical outcomes in patients achieving LDL-cholesterol targets with statins after PCI. 21 The therapeutic benefits of contemporary medical treatment with statins for the prognosis of HD patients has still not been elucidated and needs to be optimized in terms of patients' lipid control.…”