Lipid Paradox in Acute Myocardial Infarction—The Association With 30-Day In-Hospital Mortality

Cheng, Kai-Hung; Chu, Chih‐Sheng; Lin, Tsung-Hsien; Lee, Kun-Tai; Sheu, Sheng‐Hsiung; Lai, Wen‐Ter

doi:10.1097/ccm.0000000000000946

Cited by 71 publications

(65 citation statements)

References 40 publications

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“…This paradox means that patients with a greater blood cholesterol concentration have a better prognosis than subjects with a low plasma lipid level [21,22], which was found in relation to the risk of AF occurrence (Table 1), all-cause mortality, and 30-day readmission for patients without AF (Tables 2, 3D). However, in the context of the proven favourable effect of the most popular lipid-lowering drugs, statins, on CV and all-cause mortality [21], the poor prognosis linked with low Not all data were available for all calculations; therefore, the number of subjects taken into analysis is given in brackets in the title of table.…”

Section: Discussionmentioning

confidence: 97%

“…To check the importance of the "cholesterol paradox" [21,22], we added actual LDL blood concentration to the above-mentioned models (Tables 3A-D). The inclusion of this variable had no effect on the influence of nutritional status parameters on the risk of AF (Table 3A) and in-hospital death (Table 3B).…”

Section: Resultsmentioning

confidence: 99%

“…On the other hand, an NRS-2002 score was the risk factor for in-hospital death (Table 3B) and a significant risk factor for 30-day readmission (Table 3C). However, when an actual LDL-C blood concentration was included in the regression model (Table 3D), the statistical significance of BMI and NRS-2002 score as risk factors for 30-day rehospitalisation disappeared and LDL-C blood concentration was significant, weak, and negative, suggesting the presence of the "cholesterol paradox" in the hospitalised patients [21,22].…”

Section: Discussionmentioning

confidence: 99%

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The associations between atrial fibrillation and parameters of nutritional status assessment in the general hospital population — a cross-sectional analysis of medical documentation

Budzyński

Anaszewicz

2017

Kardiol Pol

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A b s t r a c tBackground: Atrial fibrillation (AF) and nutrition status abnormalities are two of the most significant epidemics in current health care. Aim:The aim of this study was to determine the relationship between the prevalence and outcome of AF, and the parameters of nutritional status among consecutive, real-life patients hospitalised in a university hospital. Methods:Analysis of the medical documentation of 4930 consecutive patients aged ≥ 18 years hospitalised for more than one day with diagnoses of cardiovascular disorders. Results:Patients admitted with a diagnosis of AF (n = 512) compared to their counterparts without AF less frequently had an NRS-2002 score ≥ 3, normal range of body mass index (BMI), higher blood haemoglobin, and lower low density lipoprotein cholesterol (LDL-C) concentration. In logistic regression analysis, the risk of a hospitalisation due to AF was negatively related to BMI, NRS-2002 score, and the value of the difference between ideal and actual body mass. Urgent admission and having an NRS--2002 score ≥ 3 remained the only significant variables determining the risk of in-hospital death. Blood concentration of LDL-C and urgent admission were the only significant variables determining risk of 30-day rehospitalisation in the studied population. Conclusions:Inpatients with AF had a lower prevalence of normal body mass. Patients with an AF diagnosis had different risk factors for in-hospital death and 30-day rehospitalisation than their counterparts with diagnosis of cardiovascular diseases but without AF; however, the parameters of nutritional status played an important role in both patient groups. The obesity and cholesterol paradoxes were also observed.

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Section: Discussionmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The associations between atrial fibrillation and parameters of nutritional status assessment in the general hospital population — a cross-sectional analysis of medical documentation

Budzyński

Anaszewicz

2017

Kardiol Pol

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“…163 Lipoproteins levels are associated with long-term cardiovascular risk; however, in the AMI setting, there is a lipid paradox: Patients with significantly lower triglycerides and low-density lipoprotein cholesterol levels have higher in-hospital 164 and 30-day mortality rates. 165 This seeming paradox may be due to competing risks of collider (index event) bias resulting from the selection of a diseased population 166 such as older age and higher rates of DM in those with lower lipoprotein levels in the acute setting. Sex specific data examining lipids at admission and AMI outcomes are lacking.…”

Section: Hypertensionmentioning

confidence: 99%

Acute Myocardial Infarction in Women

Mehta¹,

Beckie²,

DeVon³

et al. 2016

Circulation

941

393

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Cardiovascular disease is the leading cause of mortality in American women. Since 1984, the annual cardiovascular disease mortality rate has remained greater for women than men; however, over the last decade, there have been marked reductions in cardiovascular disease mortality in women. The dramatic decline in mortality rates for women is attributed partly to an increase in awareness, a greater focus on women and cardiovascular disease risk, and the increased application of evidence-based treatments for established coronary heart disease. This is the first scientific statement from the American Heart Association on acute myocardial infarction in women. Sex-specific differences exist in the presentation, pathophysiological mechanisms, and outcomes in patients with acute myocardial infarction. This statement provides a comprehensive review of the current evidence of the clinical presentation, pathophysiology, treatment, and outcomes of women with acute myocardial infarction.

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“…The initial lipid profile of patients with acute myocardial infarction may therefore hold prognostic value [5].…”

Section: Thrombolysis or Primary Percutaneous Coronary Intervention Omentioning

confidence: 99%

Can intralipid infusion open a coronary occlusion causing acute myocardial infarction?

Eldor¹

2017

Clin Med Invest

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Coronary heart disease remains the leading cause of morbidity and mortality in Western countries. The best hope of salvaging viable myocardium after a coronary occlusion is by rapid reperfusion of the ischemic myocardium, either by thrombolysis or primary percutaneous coronary intervention. The use of intravenous intralipid infusion instead of thrombolysis or primary percutaneous coronary intervention is first suggested in the medical literature.Correspondence to: Joseph Eldor, Theoretical Medicine Institute, Jerusalem, Israel, E-mail: csen_international@csen.com Key words: intralipid, myocardial infarction, coronary occlusionReceived: June 18, 2017; Accepted: July 15, 2017; Published: July 17, 2017 Thrombolysis or primary percutaneous coronary intervention or Intralipid Infusion?Coronary heart disease remains the leading cause of morbidity and mortality in Western countries. The best hope of salvaging viable myocardium after a coronary occlusion is by rapid reperfusion of the ischemic myocardium, either by thrombolysis or primary percutaneous coronary intervention. Although reperfusion restores blood flow, oxygen, and nutrients to the cardiac muscle, it also has the potential to induce reperfusion injury.Postconditioning of the heart with brief episodes of reperfusion/ occlusion at the onset of reflow has been shown to limit infarct size. However, this approach is not practical for patients treated with thrombolytic agents and therefore a more generic pharmacologic postconditioning is still needed. The ideal pharmacologic candidates need to be safe and effective when administered during the first few minutes of reperfusion by inducing cellular protection or enhancing myocardial tolerance to ischemia/reperfusion injury. Several drugs have yielded encouraging results in animals and a few have been tested in humans; however, none of these modalities has been widely accepted.Lipids and in particular polyunsaturated fatty acids have received special cardiovascular research attention because polyunsaturated fatty acid-rich diets are associated with a decreased risk of coronary artery disease. Acute application of polyunsaturated fatty acids to cardiomyocytes has also been shown to shorten action potential duration and this could account for the antiarrhythmic mechanism of the polyunsaturated fatty acids. Intralipid (Sigma, St. Louis, MO) is a brand name for the first safe fat emulsion for human use; Intralipid 20% is an emulsion of soybean oil (20%), egg yolk phospholipids (1.2%), and glycerol (2.2%). Intralipid has been widely used in patients who need total parenteral nutrition and as a vehicle for different drugs such as propofol. It has been shown recently that postischemic administration of Intralipid protects the isolated rat heart against ischemia/reperfusion injury. However, the molecular mechanism in which Intralipid mediates cardioprotection is completely unknown [1].Intralipid, a brand name for the first safe fat emulsion for human use, has been shown to be cardioprotective. However, the mechanism ...

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Lipid Paradox in Acute Myocardial Infarction—The Association With 30-Day In-Hospital Mortality

Cited by 71 publications

References 40 publications

The associations between atrial fibrillation and parameters of nutritional status assessment in the general hospital population — a cross-sectional analysis of medical documentation

The associations between atrial fibrillation and parameters of nutritional status assessment in the general hospital population — a cross-sectional analysis of medical documentation

Acute Myocardial Infarction in Women

Can intralipid infusion open a coronary occlusion causing acute myocardial infarction?

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