Key result
A lowered postoperative LDL-C/HDL-C ratio of less than 1.5 significantly decreased the risk for later cardiovascular events after abdominal aortic aneurysm surgery (HR 0.10).
Why the study?
Does achieving a postoperative LDL-C/HDL-C ratio <1.5 reduce later cardiovascular events in patients undergoing elective abdominal aortic aneurysm surgery?
Cohort (n=116)
No
Does achieving a postoperative LDL-C/HDL-C ratio <1.5 reduce later cardiovascular events in patients undergoing elective abdominal aortic aneurysm surgery?
Hazard Ratio: 0.1 (95% CI 0.01–0.83)
Absolute Event Rate: 4.5% vs 21.3%
p-value: p=0.033
Achieving a postoperative LDL-C/HDL-C ratio <1.5 is associated with a significantly reduced risk of subsequent cardiovascular events in patients who underwent elective abdominal aortic aneurysm surgery.
Should not yet change post-AAA surgery management; leaves open whether targeting LDL-C/HDL-C ratio <1.5 improves outcomes in trials.
PURPOSE: To examine the relationship between the incidence of later cardiovascular events after abdominal aortic aneurysm (AAA) surgery and postoperative lipid levels. METHODS: Atherosclerotic risk factors including postoperative serum lipid levels were examined in 116 patients aged 70 or less undergoing an elective AAA surgery. Later cardiovascular events after AAA surgery occurred in 21 patients, including cerebral infarction (n = 4), catheter intervention or surgery for coronary artery disease (CAD) (n = 10) and other vascular disease. RESULTS: Postoperative cholesterol levels during the average follow-up period of 55.6 ± 44.3 (months) were 49.0 ± 15.7 (mg/dL) for high-density lipoprotein cholesterol (HDL-C), 97.9 ± 31.2 (mg/dL) for low-density lipoprotein cholesterol (LDL-C), which were both significantly improved compared to preoperative values (p <0.001). Cox hazard analysis indicated that preexistent CAD significantly increased in the risk for later cardiovascular events (hazard ratio 5.67; 95%CI 1.92-16.8; p = 0.002) and lowered postoperative LDL-C/HDL-C ratio <1.5 decreased in the risk after AAA surgery (hazard ratio 0.10; 95%CI 0.01-0.83; p = 0.033). Patients with postoperative LDL-C/HDL-C ratio <1.5 (n = 22) had a significantly better cardiovascular event-free rate than those with that ratio ≥1.5 (n = 94) (p = 0.014). CONCLUSION: Lowered postoperative LDL-C/HDL-C ratio <1.5 can decrease in the risk for later cardiovascular events after AAA surgery. These results may support the rationale for postoperative aggressive lipid-modifying therapy.
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Kanaoka et al. (2011) conducted a cohort in abdominal aortic aneurysm (n=116). Postoperative LDL-C/HDL-C ratio <1.5 vs. Postoperative LDL-C/HDL-C ratio ≥1.5 was evaluated on Later cardiovascular events (HR 0.10, 95% CI 0.01-0.83, p=0.033). A lowered postoperative LDL-C/HDL-C ratio of less than 1.5 significantly decreased the risk for later cardiovascular events after abdominal aortic aneurysm surgery (HR 0.10).
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