Lack of protective role of HDL-C in patients with coronary artery disease undergoing elective coronary artery bypass grafting

• Published in: European heart journal Vol. 34; no. 46; pp. 3557 - 3562
• Main Authors: Angeloni, Emiliano, Paneni, Francesco, Landmesser, Ulf, Benedetto, Umberto, Melina, Giovanni, Lüscher, Thomas Felix, Volpe, Massimo, Sinatra, Riccardo, Cosentino, Francesco
• Format: Journal Article
• Language: English
• Published: England 01.12.2013
• Subjects: Aged; Cholesterol, HDL - metabolism; Cholesterol, HDL - physiology; Coronary Artery Bypass - methods; Coronary Artery Bypass - mortality; Coronary Artery Disease - mortality; Coronary Artery Disease - surgery; Elective Surgical Procedures - mortality; Epidemiologic Methods; Female; Humans; Male; Medicin och hälsovetenskap; Secondary Prevention; Secondary prevention; Dysfunctional HDL-C; Coronary artery bypass grafting; Cardiovascular mortality
• ISSN: 0195-668X; 1522-9645; 1522-9645
• DOI: 10.1093/eurheartj/eht163

Primary prevention studies have confirmed that high-density lipoprotein cholesterol (HDL-C) levels are strongly associated with reduced cardiovascular events. However, recent evidence suggests that HDL-C functionality may be impaired under certain conditions. In the present study, we hypothesize that HDL-C may lose their protective role in the secondary prevention of coronary artery disease (CAD). A consecutive series of 1548 patients undergoing isolated first-time elective CABG at one institution between 2004 and 2009 was studied. According to the ATPIII criteria, pre-operative HDL-C values were used to identify patients with high (Group A) vs. low HDL-C (Group B). To eliminate biased estimates, a propensity score model was built and two cohorts of 1:1 optimally matched patients were obtained. Cumulative survival and major adverse cardiovascular events (MACE) were analysed by means of Kaplan-Meier method. Cox proportional-hazards regression models were used to identify independent predictors of MACE and death. Propensity matching identified two cohorts of 502 patients each. At a median follow-up time of 32 months, there were 44 out of 502 (8.8%) deaths in Group A and 36 out of 502 deaths in Group B (7.2%, HR 1.19; P = 0.42). MACE occurred in 165 out of 502 (32.9%) in Group A and 120 out of 502 (23.9%) in Group B (P = 0.04). Regression analysis showed that pre-operative HDL-C levels were not associated with reduced but rather increased MACE occurrence during follow-up (HR 1.43, P = 0.11). Higher HDL-C levels are not associated with reduced risk of vascular events in CAD patients undergoing CABG. Our findings may support efforts to improve HDL-C functionality instead of increasing their levels.