Dyslipidemia Patterns in Adults with Congenital Heart Disease: Focus on HDL Cholesterol

Introduction: As survival in congenital heart disease (CHD) improves, identifying modifiable cardiovascular risk factors like dyslipidemia becomes increasingly important, though its features in adult CHD remain understudied. Methods: A retrospective study of 521 CHD patients (mean age 34 ± 14 years, 58% male) and 1782 matched controls (mean age 33 ± 11 years, 55% male) was conducted. Lipid profiles were assessed cross-sectionally at a single time point, and arterial thrombosis events were recorded over a mean follow-up of 5.8 years. Results: CHD patients had significantly lower total cholesterol (164.5 vs. 180.6 mg/dL), LDL (94.9 vs. 107.0 mg/dL), HDL (49.7 vs. 53.1 mg/dL), and triglycerides (97.0 vs. 102.4 mg/dL) compared to controls (all p < 0.05). Low HDL cholesterol (<40 mg/dL) was observed in 20% of CHD patients, nearly double the prevalence in the control group (11.6%; p < 0.001). This abnormality increased with CHD complexity: 15.2% in simple, 22.6% in moderate, and 28.9% in complex lesions. The proportion of patients with HDL < 40 mg/dL was higher in those with ventricular hypoplasia and Eisenmenger syndrome (p = 0.027). These groups also exhibited significantly higher NT-pro BNP levels, with a trend toward elevated C-reactive protein (CRP). Arterial thrombosis occurred in 4.0% of CHD patients versus 0.5% of controls (p < 0.001), with no significant differences between CHD subtypes. While overall lipid parameters did not differ significantly, the combination of low HDL and high LDL levels (mixed LDL + HDL pattern) was more common among patients with thrombosis (p = 0.005), although this association lost significance in binary logistic regression analysis. Conclusions: CHD patients exhibit a distinct lipid profile marked by lower HDL levels, particularly in complex cases and high-risk subtypes. Although the mixed low HDL/high LDL pattern was linked to thrombosis, this association was not maintained in multivariable analysis.