Lack of protective role of HDL-C in patients with coronary artery disease undergoing elective coronary artery bypass grafting
Lack of protective role of HDL-C in patients with coronary artery disease undergoing elective coronary artery bypass grafting
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DOI：
10.1093/eurheartj/eht163
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发表时间：
2013-12-01
影响因子：
39.3
通讯作者：
Cosentino, Francesco
中科院分区：
文献类型：
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作者：
Angeloni, Emiliano;Paneni, Francesco;Cosentino, Francesco
一级预防研究已经证实，高密度脂蛋白胆固醇（HDL-C）水平与心血管事件的减少密切相关。然而，最近的证据表明，HDL-C功能可能会在某些条件下受损。在本研究中，我们假设，HDL-C可能会失去其保护作用，在二级预防冠状动脉疾病（CAD）。方法和结果一个连续的系列1548例患者进行隔离的第一次选择性冠状动脉旁路移植术在2004年和2009年之间的一个机构进行了研究。根据ATP III标准，术前HDL-C值用于识别高HDL-C（A组）与低HDL-C（B组）患者。为了消除偏倚估计，建立倾向评分模型，并获得两个1：1最佳匹配患者队列。采用Kaplan-Meier法分析累积生存率和主要不良心血管事件（MACE）。采用考克斯比例风险回归模型确定MACE和死亡的独立预测因素。倾向匹配确定了两个队列，每个队列502例患者。中位随访时间为32个月，A组502例患者中有44例（8.8%）死亡，B组502例患者中有36例死亡（7.2%，HR 1.19; P=0.42）。A组502例患者中165例（32.9%）发生MACE，B组502例患者中120例（23.9%）发生MACE（P=0.04）。回归分析显示，术前HDL-C水平与术后MACE发生率无相关性（HR 1.43，P=0.11）。我们的研究结果可能支持改善HDL-C功能的努力，而不是增加其水平。
Aims 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).Methods and results 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).Conclusion 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.