Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
Am J Cardiol. 2021 May 1;146:8-14. doi: 10.1016/j.amjcard.2021.01.014. Epub 2021 Jan 31.
Several studies designed to augment high density lipoprotein (HDL) levels have so far been unsuccessful in reducing rates of major adverse cardiovascular and cerebrovascular events (MACCE). In this study, we report the effect of HDL-C levels on overall survival outcomes and rates of MACCE following percutaneous coronary intervention (PCI). We reviewed patients who underwent PCI at the Cleveland Clinic from 2005 to 2017 and followed them through the end of 2018. Restricted cubic splines incorporated into Cox proportional hazard regression models were used to assess the outcomes. The HDL-C level associated with the lowest mortality was used as a reference value.15,633 patients underwent PCI during the study period, of which 70% were male, 81% were white, and 73% were on statins. The mean age at the time of procedure was 65.8 ± 11.8 years. After adjusting for demographics, co-morbidities, lipid profile, statin use, and date of procedure, our model demonstrated a U-shaped association between HDL-C and overall mortality, with HDL-C levels of 30-50 mg/dl associated with the most favorable outcomes, and HDL-C levels < 30 mg/dl or > 50 mg/dl associated with worse outcomes. A sensitivity analysis in men yielded a similar U-shaped association. In conclusion, our study shows that both low and high levels of HDL-C are associated with worse overall survival, with no effect on rates of MACCE in PCI patients. Further studies are required to understand the mechanism of this association between elevated HDL-C levels with increased overall mortality in patients with atherosclerotic cardiovascular disease (ASCVD).
几项旨在提高高密度脂蛋白 (HDL) 水平的研究迄今为止未能降低主要不良心血管和脑血管事件 (MACCE) 的发生率。在这项研究中，我们报告了 HDL-C 水平对经皮冠状动脉介入治疗 (PCI) 后总体生存结果和 MACCE 发生率的影响。我们回顾了 2005 年至 2017 年在克利夫兰诊所接受 PCI 的患者，并随访至 2018 年底。 Cox 比例风险回归模型中纳入的限制立方样条用于评估结果。将与最低死亡率相关的 HDL-C 水平用作参考值。在研究期间，15633 例患者接受了 PCI，其中 70%为男性，81%为白人，73%服用他汀类药物。手术时的平均年龄为 65.8 ± 11.8 岁。在调整了人口统计学、合并症、血脂谱、他汀类药物使用和手术日期后，我们的模型显示 HDL-C 与总体死亡率之间呈 U 形关联，HDL-C 水平在 30-50mg/dl 时与最佳结果相关，HDL-C 水平 < 30mg/dl 或 > 50mg/dl 与更差的结果相关。对男性进行的敏感性分析得出了类似的 U 形关联。总之，我们的研究表明，低水平和高水平的 HDL-C 都与总体生存率较差相关，与 PCI 患者的 MACCE 发生率无关。需要进一步研究来了解这种与 ASCVD 患者 HDL-C 水平升高导致总体死亡率增加之间的关联的机制。
