A V-shaped association between high-density lipoprotein cholesterol levels and poor outcomes in patients after percutaneous coronary intervention

• Published in: International journal of cardiology Vol. 400; p. 131773
• Main Authors: Chen, Xiao-Fang, Xiang, Yi-Fei, Cai, Xiao-Ling, Chen, Jun-Han, Lin, Xue-Qin, Lin, Bi-Ting, Liang, Wen-Jia, Zhou, Geng-Yu, Guo, Yan-Song, Lin, Kai-Yang
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.04.2024
• Subjects: High density lipoprotein cholesterol; Percutaneous coronary intervention; Poor outcomes; High density lipoprotein cholesterol; Poor outcomes; Percutaneous coronary intervention
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2024.131773

High density lipoprotein cholesterol (HDL-C) is considered as “good cholesterol”. Recent evidence suggests that a high HDL-C level may increase the risk of poor outcomes in some populations. To investigate the association between HDL-C levels and poor outcomes in patients after percutaneous coronary intervention (PCI). Patients undergoing PCI during January 2012 and December 2018 were consecutively recruited and divided into three groups with different HDL-C levels: HDL-C ≤ 25 mg/dL, 25 < HDL-C ≤ 60 mg/dL, HDL-C > 60 mg/dL by the restricted cubic spline (RCS) analysis and assessed for all-cause mortality (ACM). The association between HDL-C levels and poor outcomes was assessed by multivariable cox regression analysis. The patients were followed with a median duration of 4 years. Of the 7284 participants, 727 all-cause deaths and 334 cardiovascular deaths occurred. A V-shaped association of HDL-C with the prognosis was observed, patients with either excessively low or high HDL-C levels reporting a higher risk than those with midrange values. After adjustment for confounding factors, the former exhibited a higher cumulative rate of ACM and cardiovascular mortality (CM) than the latter [low HDL-C: for ACM, hazard ratio (HR), 1.96; 95%CI, 1.41, 2.73, P < 0.001; for CM, HR, 1.66; 95%CI, 1.03, 2.67; P = 0.037; high HDL-C: for ACM, HR, 1.73; 95%CI, 1.29, 2.32, P < 0.001; for CM, HR, 1.73; 95%CI, 1.16, 2.58; P = 0.007]. HDL-C levels display a V-shaped association with poor outcomes in patients after PCI, with excessively high or low HDL-C suggesting a higher mortality risk. An optimal HDL-C level may fall in the range of 25-60 mg/dL. •We evaluated that a bit higher HDL-C levels, just >60 mg/dL, begin to show an sharply increased risk of mortality.•Our results suggested the relationship between HDL-C levels and prognosis is more like a V-shaped curve rather than a U-shaped curve or J-shaped curve in PCI population.•Our study focused on the high risk patients with CAD underwent PCI, whose blood lipid control should be more strict, and HDL-C levels also should be paid more attention.•Our study was the first time to further analyze each subgroup of PCI population, including age, gender, diabetes, smoker, MI, and whether to perform pPCI.