Key result
HDL-C <28 mg/dL is linked to ~38% higher in-hospital major bleeding risk, peaking alongside low LDL-C.
Why the study?
Do low levels of LDL-C and HDL-C jointly increase the risk of in-hospital major bleeding in Chinese patients with acute coronary syndrome undergoing PCI?
Observational (n=42,378)
Yes
Do low levels of LDL-C and HDL-C jointly increase the risk of in-hospital major bleeding in Chinese patients with acute coronary syndrome undergoing PCI?
Odds Ratio: 1.38 (95% CI 1.07–1.79)
p-value: p=0.014
In patients with ACS undergoing PCI, low levels of both LDL-C and HDL-C are jointly associated with an increased risk of in-hospital major bleeding, highlighting the need to consider lipid profiles when assessing bleeding risk.
May refine bleeding risk stratification post-ACS PCI; leaves open causal effects and practice implications.
Low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) have each been associated with bleeding risk; however, their joint association with bleeding outcomes remains insufficiently characterized. We included patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) and were enrolled in the Improving Care for Cardiovascular Disease in China-ACS project between 2014 and 2019. This study was registered at ClinicalTrials.gov (NCT02306616) on November 29, 2014. Restricted cubic spline analysis assessed dose–response relationships, and multivariable fractional polynomial interaction analysis evaluated lipoprotein interdependence. Heatmaps visualized risk patterns across LDL-C/HDL-C combinations. Among 42,378 patients, 615 in-hospital major bleeding events were recorded. Restricted cubic spline analysis revealed a J-shaped association between HDL-C and bleeding risk, with HDL-C levels below 28 mg/dL associated with a 38% increased bleeding risk (adjusted odds ratio 1.38, 95% CI 1.07–1.79). In the multivariable fractional polynomial interaction analysis, the higher estimated bleeding risk associated with LDL-C < 70 mg/dL was most evident at HDL-C levels below approximately 45 mg/dL ( P for interaction = 0.012), whereas the reverse interaction analysis for HDL-C < 28 mg/dL across continuous LDL-C levels was not statistically significant ( P for interaction = 0.608). Heatmap visualization showed higher estimated bleeding risks when both LDL-C and HDL-C were in lower ranges. In this nationwide ACS registry, HDL-C showed a J-shaped association with in-hospital major bleeding, and LDL-C and HDL-C were jointly associated with in-hospital major bleeding among patients undergoing PCI. Higher estimated risk was observed when both lipoproteins were in lower ranges, consistent with a conditional joint risk pattern.
No takes yet. Share an insight, caveat, or question.
Zhu et al. (2026) conducted an observational in Acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) (n=42,378). HDL-C < 28 mg/dL vs. HDL-C ≥ 28 mg/dL was evaluated on In-hospital major bleeding (OR 1.38, 95% CI 1.07-1.79, p=0.014). HDL-C levels below 28 mg/dL were associated with a 38% increased risk of in-hospital major bleeding (OR 1.38) compared to higher levels, with the highest risk seen when both HDL-C and LDL-C were low.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: