Low-density lipoprotein cholesterol and survival in pulmonary arterial hypertension

Abstract

Low-density lipoprotein cholesterol(LDL-C) is a well established metabolic marker of cardiovascular risk, however, its role in pulmonary arterial hypertension (PAH) has not been determined. Therefore we assessed whether LDL-C levels are altered in PAH patients, if they are associated with survival in this group and whether pulmonary hypertension (PH) reversal can influence LDL-C levels. Consecutive 46 PAH males and 94 females were age matched with a representative sample of 1168 males and 1245 females, respectively. Cox regression models were used to assess the association between LDL-C and mortality. The effect of PH reversal on LDL-C levels was assessed in 34 patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing invasive treatment. LDL-C was lower in both PAH (2.6 ± 0.8 mmol/l) and CTEPH (2.7 ± 0.7 mmol/l) patients when compared to controls (3.2 ± 1.1 mmol/l, p < 0.001). In PAH patients lower LDL-C significantly predicted death (HR:0.44/1 mmol/l, 95%CI:0.26–0.74, p = 0.002) after a median follow-up time of 33(21–36) months. In the CTEPH group, LDL-C increased (from 2.6[2.1–3.2] to 4.0[2.8–4.9]mmol/l, p = 0.01) in patients with PH reversal but remained unchanged in other patients (2.4[2.2–2.7] vs 2.3[2.1–2.5]mmol/l, p = 0.51). We concluded that LDL-C level is low in patients with PAH and is associated with an increased risk of death. Reversal of PH increases LDL-C levels.

Cardiac Manifestations in Systemic Lupus Erythematosus: Clinical Correlates of Subclinical Echocardiographic Features

“…In agreement with this finding, Kopec et al reported recently significantly lower LDL levels in PAH patients, including those with connective tissue diseases, compared to controls, and lower LDL levels were significantly associated with high mortality rate from PAH [36]. Moreover, the reversal of chronic thromboembolic PAH has raised levels of LDL compared to unchanged levels in patients with non-reversed chronic thromboembolic PAH [36]. Unexpectedly, there was no association between the presence of vasculitis or Raynaud's phenomenon and PAH.…”

Triglyceride-to-High-Density Lipoprotein Cholesterol Ratio and Systemic Inflammation in Patients with Idiopathic Pulmonary Arterial Hypertension

“…We collected venous blood from each participant after 12 h of fasting on the day of hemodynamic assessment. Complete lipid profile was assessed using the direct colorimetric method, as described previously [5]. Insulin concentration was assessed using electro-chemiluminescence immunoassay (Roche, Switzerland).…”

“…Recent clinical studies found alterations in lipid profile, such as elevated triglyceride (TG)-to-high-density lipoprotein cholesterol (HDL-C) ratio and lowered HDL-C, to be more prevalent in pulmonary arterial hypertension (PAH) patients than in age-matched controls [4,5]. Both of them were associated with poor survival [4] and worse clinical status in this population [6].…”

Pulmonary vascular dysfunction in metabolic syndrome

“…Furthermore, Kopec et al . () reported that the serum concentration of LDLs is associated with increased mortality. These data suggest that the serum HDL or LDL levels in PAH patients is indicative of the severity and survivability of PAH.…”