Key result
High HDL-C (≥ 60 mg/dL) reduced all-cause mortality by 53% (aHR 0.47) compared to normal HDL-C in normal-weight CABG patients, but this protective effect was lost in obese patients.
Why the study?
Despite the recognized role of HDL-C in cardiovascular diseases, the potential modifying effect of BMI on the association between HDL-C and post-CABG outcomes remained unclear.
Does BMI modify the association between HDL-C levels and post-CABG outcomes (mortality and MACCE) in patients undergoing isolated CABG?
Cohort (n=15,639)
No
Does BMI modify the association between HDL-C levels and post-CABG outcomes (mortality and MACCE) in patients undergoing isolated CABG?
Effect estimate: aHR 0.47 (95% CI 0.242-0.919)
p-value: p=0.027
Very high HDL-C (≥ 60 mg/dL) is protective against mortality in normal and overweight patients undergoing CABG, but this protective effect is lost in obese patients.
BACKGROUND: Despite the recognized implications of high-density lipoprotein cholesterol (HDL-C) in cardiovascular diseases, the role of body mass index (BMI) in HDL-C association with cardiovascular outcomes remains unclear. This study investigated the possible modifying implications of BMI on the correlation between HDL-C and coronary artery bypass grafting (CABG) outcomes. METHODS: . Cox proportional hazard models (CPHs) and restricted cubic splines (RCSs) were applied to evaluate the relationship between HDL-C and all-cause mortality as well as major adverse cardio-cerebrovascular events (MACCEs) in different BMI categories. RESULTS: This study enrolled a total of 15,639 patients. Considering the final Cox analysis among the normal and overweight groups, HDL-C ≥ 60 was a significant protective factor compared to 40 < HDL-C < 60 for all-cause mortality (adjusted hazard ratio (aHR): 0.47, P: 0.027; and aHR: 0.64, P: 0.007, respectively). However, the protective effect of HDL-C ≥ 60 was no longer observed among patients with 30 ≤ BMI < 35 (aHR: 1.16, P = 0.668). RCS trend analyses recapitulated these findings; among 30 ≤ BMI < 35, no uniform inverse linear association was observed; after approximately HDL-C≈55, its increase was no longer associated with reduced mortality risk. RCS analyses on MACCE revealed a plateau effect followed by a modest rise in overweight and obese patients from HDL-C = 40 onward (nonlinear association). CONCLUSIONS: Very high HDL-C (≥ 60 mg/dL) was not related to better outcomes among obese CABG patients. Furthermore, HDL-C was related to the post-CABG outcomes in a nonlinear manner, and the magnitude of its effects also differed across BMI subgroups.
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Rezaee et al. (2022) conducted a cohort in Coronary artery disease undergoing isolated CABG (n=15,639). High HDL-C (≥ 60 mg/dL) vs. Normal HDL-C (40 < HDL-C < 60 mg/dL) was evaluated on All-cause mortality in normal weight patients (18.5 ≤ BMI < 25) (aHR 0.47, 95% CI 0.242-0.919, p=0.027). High HDL-C (≥ 60 mg/dL) reduced all-cause mortality by 53% (aHR 0.47) compared to normal HDL-C in normal-weight CABG patients, but this protective effect was lost in obese patients.
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