Key result
Low HDL-C is linked to ~2-fold higher all-cause mortality in pre-capillary pulmonary hypertension.
Why the study?
The impact of lipid abnormalities on right heart function and outcomes in pre-capillary pulmonary hypertension remained unclear.
Does decreased HDL-C (<0.82 mmol/L) or LDL-C (<1.93 mmol/L) increase the risk of all-cause mortality and right heart dysfunction in patients with pre-capillary pulmonary hypertension?
Cohort (n=394)
CMR strain analysis performed by a reader blinded to clinical data and other CMR information
No
Does decreased HDL-C (<0.82 mmol/L) or LDL-C (<1.93 mmol/L) increase the risk of all-cause mortality and right heart dysfunction in patients with pre-capillary pulmonary hypertension?
Decreased HDL-C and LDL-C levels independently predict mortality and provide incremental prognostic value beyond ESC and ESC-CMR risk models in pre-capillary pulmonary hypertension, with low HDL-C specifically linked to impaired right heart function and strain.
Answers are grounded in this paper and cite their sources.
Low HDL-C and LDL-C should not yet guide PH management; leaves open whether lipid modulation affects mortality or right heart function.
Background and Objective The impact of lipid abnormalities on right heart function and outcomes in pre‐capillary pulmonary hypertension (precPH) remains unclear. This study investigates how lipid profile alterations influence right heart function, strain, and prognosis in precPH patients. Methods From June 2013 to December 2023, 394 precPH patients were prospectively enrolled. Clinical data, cardiac MRI‐derived right heart systolic function, and strain parameters were compared among groups based on lipid profiles. The optimal cut‐off values of lipid profiles were determined using the maximally selected rank statistics. Prognostic analyses were conducted using Cox regression and Kaplan–Meier survival methods. Results During a median follow‐up of 36 months, 18.8% of patients died. Low‐density lipoprotein cholesterol (LDL‐C) < 1.93 mmol/L and high‐density lipoprotein cholesterol (HDL‐C) < 0.82 mmol/L were associated with increased mortality risks (2.51‐fold and 2.65‐fold, respectively). Multivariate analysis confirmed decreased LDL‐C (HR 1.853, 95% CI 1.102–3.115, p = 0.02) and decreased HDL‐C (HR 2.019, 95% CI 1.131–3.603, p = 0.02) as independent prognostic indicators. A decrease in either cholesterol subtype predicted worse outcomes (Log‐rank p = 0.003). Incorporation of LDL‐C and HDL‐C enhanced prognostic accuracy of the ESC model (χ 2 : 50.8 to 60.5, p = 0.007; 50.8 to 66.0, p < 0.001) and ESC‐CMR model (χ 2 : 59.3 to 66.0, p = 0.04; 59.3 to 72.7, p = 0.001). HDL‐C < 0.82 mmol/L was associated with impaired right ventricular global longitudinal strain ( p < 0.001), RV free wall strain ( p < 0.001), and right atrial phasic strain (all p < 0.05). Conclusions Decreased HDL‐C and LDL‐C levels independently predict increased mortality in precPH patients. Notably, low HDL‐C significantly associates with impaired right heart function and strain. Trial Registration Chinese Clinical Trial Registry ( https://www.clinicaltrials.gov ; ID: ChiCTR1800019314 and ChiCTR1900025518)
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Guo et al. (2025) conducted a cohort in Pre-capillary pulmonary hypertension (precPH) (n=394). Decreased HDL-C (<0.82 mmol/L) and decreased LDL-C (<1.93 mmol/L) vs. Normal HDL-C (≥0.82 mmol/L) and normal LDL-C (≥1.93 mmol/L) was evaluated on All-cause mortality (HR 2.019, 95% CI 1.131–3.603, p=0.02). Decreased HDL-C and decreased LDL-C independently predicted increased all-cause mortality in pre-capillary PH patients.
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