Patterns and prognostic implications of low high-density lipoprotein levels in patients with non-ST-segment elevation acute coronary syndromes

• Published in: European heart journal Vol. 29; no. 20; pp. 2480 - 2488
• Main Authors: Roe, Matthew T., Ou, Fang-Shu, Alexander, Karen P., Newby, Laura Kristin, Foody, Joanne M., Gibler, W. Brian, Boden, William E., Ohman, Erik Magnus, Smith, Sidney C., Peterson, Eric D.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.10.2008; Oxford Publishing Limited (England)
• Subjects: Acute Coronary Syndrome - blood; Acute Coronary Syndrome - drug therapy; Acute Coronary Syndrome - mortality; Aged; Angina, Unstable - blood; Angina, Unstable - drug therapy; Angina, Unstable - mortality; Biological and medical sciences; Biomarkers - blood; Body Mass Index; Cardiology. Vascular system; Coronary Artery Disease - blood; Coronary Artery Disease - drug therapy; Coronary Artery Disease - mortality; Coronary heart disease; Female; Heart; High-density lipoprotein cholesterol; Hospital Mortality; Humans; Lipoproteins, HDL - blood; Male; Medical sciences; Middle Aged; Myocarditis. Cardiomyopathies; Non-ST-segment elevation acute coronary syndromes; Prognosis; Risk Assessment; Severity of Illness Index; Sex Distribution; Non-ST-segment elevation acute coronary syndromes; High-density lipoprotein cholesterol; Prognosis; High; Human; Cardiovascular disease; Coronary heart disease; Myocardial disease; Density; Cholesterol; Lipoprotein LDL; ST elevation; Level; Circulatory system; Cardiology; Acute coronary syndrome
• DOI: 10.1093/eurheartj/ehn364
• ISSN: 0195-668X

Aims The patterns and prognostic significance of low high-density lipoprotein (HDL) cholesterol levels have not been well characterized. We sought to determine the prevalence and prognostic significance of low HDL cholesterol levels in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS). Methods and results We evaluated HDL levels among NSTE ACS patients [ischaemic ECG (electrocardiogram) changes and/or positive cardiac markers] from the CRUSADE [Can Rapid Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC(American College of Cardiology)/AHA(American Heart Association) Guidelines] initiative treated at 555 US hospitals from January 2001 through June 2006. Clinical and angiographic characteristics, treatments, and in-hospital outcomes were analysed by categories of HDL levels measured during hospitalization. Among 93 263 NSTE ACS patients with HDL measurements, 16 854 (18.1%) had very low HDL levels (10–29 mg/dL), 32 185 (34.5%) had low HDL levels (30–39 mg/dL), 35 875 (38.5%) had normal HDL levels (40–59 mg/dL), and 8349 (9.0%) had high HDL levels (60–100 mg/dL). Patients with very low HDL levels were younger, more often male, and more commonly obese and diabetic. Patients with very low HDL levels had the greatest risk of multi-vessel coronary disease on angiography and in-hospital mortality compared with patients with normal and high HDL levels. Conclusion Almost one-fifth of patients with NSTE ACS have very low HDL levels – a finding that adds incrementally to a greater burden of atherosclerosis and a higher risk of mortality. Consequently, strategies for mitigating the adverse prognosis associated with very low HDL levels warrant further exploration in patients with ACS.