Preoperative HDL-C Predicts Later Cardiovascular Events after Abdominal Aortic Aneurysm Surgery

Abstract

Purpose: To determine the predictive value of serum lipid levels on the development of later cardiovascular events after abdominal aortic aneurysm (AAA) surgery. Methods: A total of 101 patients under 70 undergoing an elective AAA surgery were divided into the following two groups: 1) those who developed later cardiovascular events after AAA surgery, including cerebral infarction (n = 4), catheter intervention (PCI) or surgery for coronary artery disease (CAD) (n = 9) and other vascular disease. (CVE group; n = 19); 2) those without later events (NoCVE group: n = 82). Preoperative atherosclerotic risk factors including serum lipid levels were subjected to univariate and multivariate analysis. Results:The CVE group showed a significantly lower high-density lipoprotein cholesterol (HDL-C) level (32.9 ± 6.6 vs 41.6 ± 12.1 mg/dL; p <0.001), higher low-density lipoprotein cholesterol (LDL-C) / HDL-C ratio (4.30 ± 1.01 vs 3.24 ± 1.15; p = 0.001), and higher prevalence of mild CAD (without an indication of PCI) (p = 0.029) preoperatively. Cox hazard analysis indicated that preexistent mild CAD (hazard ratio 4.70) and preoperative HDL-C <35 mg/dL (hazard ratio 3.07) were significant predictors for later cardiovascular events after AAA surgery. Conclusion: Patients at high risk for later cardiovascular events should require a careful follow-up and may also require an aggressive lipid-modifying therapy.

Lowered Postoperative Ldl-C/Hdl-C Ratio Reduces Later Cardiovascular Events after Abdominal Aortic Aneurysm Surgery

“…These results may suggest that risk for later cardiovascular events could be reduced even in patients with low preoperative HDL-C levels, i.e., those at high risk for later cardiovascular events. Preoperative HDL-C level is indeed a strong predictor for later cardiovascular events as shown in the previous report, 14) but the high risk could be modified depending on postoperative management. For that purpose, intensive control of lipid levels would be necessary that can achieve the lowered LDL-C/ HDL-C ratio as low as less than 1.5.…”

“…In our previous report, further decrease in the preoperative HDL-C levels increases in the risk for cardiovascular events after AAA surgery. 14) There was about a three-fold higher risk for the development of cardiovascular events in those with the preoperative HDL-C levels <35 mg/dL. Preoperative LDL-C/HDL-C ratio was also predictive, but the value was less than simple HDL-C levels.…”

“…13) We have previously reported that lowered preoperative HDL-C <35 mg/dL was one of significant predictors for developing later cardiovascular events after AAA surgery. 14) In this previous paper, we conducted detailed investigation on the preoperative characteristics of patients with or without later cardiovascular events. 14) The next point should be the issue as to whether postoperative lipid-modifying therapy can decrease in the risk for later cardiovascular events and improve the prognosis after AAA surgery, even in the high-risk patient group.…”

“…14) In this previous paper, we conducted detailed investigation on the preoperative characteristics of patients with or without later cardiovascular events. 14) The next point should be the issue as to whether postoperative lipid-modifying therapy can decrease in the risk for later cardiovascular events and improve the prognosis after AAA surgery, even in the high-risk patient group. For that purpose, we retrospectively analyzed the postoperative serum lipid levels and other atherosclerotic risk factors related to cardiovascular events occurrence in patients undergoing AAA surgery.…”

Lowered LDL-C Levels Reduce Later Local Vascular Events after Surgical or Endovascular Treatment of Peripheral Artery Disease

“…In patients with AAA, our group has reported the relationship between the lipid levels and later cardiovascular events after surgical treatment for AAA. 25) The relationship between lipid levels and later cardiovascular events in patients with PAD would be also worth reporting.…”