What are the key findings of this study?

In patients with NSTEMI undergoing PCI, high-risk HDL-C levels ( 55 mg/dL) were associated with an increased risk of MACCE compared to low-risk levels (35-55 mg/dL) (OR 1.645).

What is the clinical evidence from this study?

Study design: Cohort. Population: Myocardial infarction (NSTEMI) undergoing PCI (n=1934). Intervention: High-risk HDL-C ( 55 mg/dL) vs. Low-risk HDL-C (35-55 mg/dL). Primary outcome: Major adverse cardiac and cerebrovascular events (MACCE) (OR 1.645, p=0.006).

July 17, 2023Open Access

Very high HDL-C (high-density lipoprotein cholesterol) is associated with increased cardiovascular risk in patients with NSTEMI (non-ST-segment elevation myocardial infarction) undergoing PCI (percutaneous coronary intervention)

Key Result

In patients with NSTEMI undergoing PCI, high-risk HDL-C levels (<35 and >55 mg/dL) were associated with an increased risk of MACCE compared to low-risk levels (35-55 mg/dL) (OR 1.645).

Study Design

Type

Cohort (n=1,934)

Blinding

Open-label

Multicenter

Structured PICO

Is there a U-shaped association between HDL-C levels and cardiovascular events in patients with myocardial infarction undergoing PCI?

Population

1,934 patients with myocardial infarction (29.3% STEMI, 70.7% NSTE-ACS) undergoing percutaneous coronary intervention, age ≥18 years, from a single high-volume center in China.

Intervention

High HDL-C levels (>80 mg/dL or >55 mg/dL depending on the analysis group)

Comparator

Low to medium HDL-C levels (e.g., 35-55 mg/dL)

Outcome

Composite of major adverse cardiac and cerebrovascular events (MACCE), defined as death, MI, and stroke, at median 29.8 months follow-upcomposite

In patients with NSTEMI undergoing PCI, there is a U-shaped association between HDL-C levels and MACCE, with both very low and very high levels increasing cardiovascular risk.

Main Result

Effect estimate: OR 1.645

Absolute Event Rate: 14.3% vs 9.7%

p-value: p=0.006

Limitations

Single-center observational study limits generalizability
Small number of patients with very high HDL-C
Post-PCI management varied considerably compared to current clinical standards
Applied logistic regression analysis instead of COX proportional hazards model due to lack of time-event data
Baseline information did not contain lipoprotein(a)

Abstract

BACKGROUND: Studies in populations with or without cardiovascular disease have shown that very high HDL-C levels are associated with an increased risk of cardiovascular events. However, the exact relationship between HDL-C levels and long-term prognosis remains unknown in patients with myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI). METHODS: This was a post hoc secondary analysis of long-term follow-up results in patients undergoing PCI open-label, observational cohort study. Patients with MI who had undergone PCI were enrolled. Restricted cubic spline (RCS) analysis and logistic regression analysis were performed to assess the relationship between HDL-C levels and the risk of cardiovascular events. RESULTS: A total of 1934 patients with MI undergoing PCI were enrolled in our analysis and our population was divided in 3 groups according to the HDL-C plasma levels: HDL-C 80 mg/dL (high HDL-C). RCS analysis showed a nonlinear U-shaped association between HDL-C levels and major adverse cardiac and cerebrovascular events (MACCE) in patients with NSTEMI with adjusted variables. After adjusting for potential confounders, the follow-up analysis indicated that high risk group had elevated occurrence of MACCE than low risk group (HDL-C 35 and 55 mg/dL) (OR:1.645, P = 0.006). CONCLUSIONS: Our analysis demonstrated that there is a U-shaped association between HDL-C and MACCE in patients with NSTEMI undergoing PCI.

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