European Heart Journal Advance Access originally published online on August 20, 2008
European Heart Journal 2008 29(20):2480-2488; doi:10.1093/eurheartj/ehn364
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Patterns and prognostic implications of low high-density lipoprotein levels in patients with non-ST-segment elevation acute coronary syndromes
1 Division of Cardiovascular Medicine, Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Box 3850, 2400 Pratt Street, Durham, NC 27705, USA
2 Brigham and Women’s Hospital, Boston, MA, USA
3 University of Cincinnati College of Medicine, Cincinnati, OH, USA
4 Western New York Veterans Affairs (VA) Healthcare Network and Buffalo General Hospital–SUNY, Buffalo, NY, USA
5 Center for Cardiovascular Science and Medicine, University of North Carolina, Chapel Hill, NC, USA
Received 7 May 2008; revised 7 July 2008; accepted 17 July 2008; online publish-ahead-of-print 20 August 2008.
* Corresponding author. Tel: +1 919 668 8959, Fax: +1 919 668 7059, Email: matthew.roe{at}duke.edu; roe00001{at}mc.duke.edu
Aims: The patterns and prognostic significance of low high-density lipoprotein (HDL) cholesterol levels have not been well characterized. We sought to determine the prevalence and prognostic significance of low HDL cholesterol levels in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS).
Methods and results: We evaluated HDL levels among NSTE ACS patients [ischaemic ECG (electrocardiogram) changes and/or positive cardiac markers] from the CRUSADE [Can Rapid Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC(American College of Cardiology)/AHA(American Heart Association) Guidelines] initiative treated at 555 US hospitals from January 2001 through June 2006. Clinical and angiographic characteristics, treatments, and in-hospital outcomes were analysed by categories of HDL levels measured during hospitalization. Among 93 263 NSTE ACS patients with HDL measurements, 16 854 (18.1%) had very low HDL levels (10–29 mg/dL), 32 185 (34.5%) had low HDL levels (30–39 mg/dL), 35 875 (38.5%) had normal HDL levels (40–59 mg/dL), and 8349 (9.0%) had high HDL levels (60–100 mg/dL). Patients with very low HDL levels were younger, more often male, and more commonly obese and diabetic. Patients with very low HDL levels had the greatest risk of multi-vessel coronary disease on angiography and in-hospital mortality compared with patients with normal and high HDL levels.
Conclusion: Almost one-fifth of patients with NSTE ACS have very low HDL levels – a finding that adds incrementally to a greater burden of atherosclerosis and a higher risk of mortality. Consequently, strategies for mitigating the adverse prognosis associated with very low HDL levels warrant further exploration in patients with ACS.
Key Words: High-density lipoprotein cholesterol • Non-ST-segment elevation acute coronary syndromes • Prognosis