Abstract 1343: High High Density Lipoprotein is Protective Against Recurrent Cardiovascular Events Regardless of the Low Density Lipoprotein Levels in Patients Undergoing Percutaneous Intervention with Drug-eluting Stents
Background: High density lipoprotein cholesterol (HDL) is known to have protective cardiovascular effects. We aimed to investigate the impact of high and low HDL levels in patients with high and low low density lipoprotein cholesterol (LDL) on the clinical outcomes of patients undergoing elective drug-eluting stent (DES) implantation.
Methods: We analyzed data of 1815 consecutive patients who presented for elective percutaneous coronary intervention (PCI) with DES implantation. This population was comprised of 4 subgroups: high LDL with high HDL, high LDL with low HDL, low LDL with high HDL, and low LDL with low HDL. High LDL was defined as ≥ 100 mg/dl, low LDL as <100 mg/dl, high HDL was defined as ≥40mg/dl for males, and ≥45mg/dl for females, and low HDL as <40mg/dl for males and <45mg/dl for females. The assessed endpoints, death, Q-wave myocardial infarction (MI), target vessel revascularization (TVR), and a composite of major adverse cardiac events (MACE) were then compared among groups.
Results: The overall statin usage at discharge was similar in all groups with approximately 98% of patients in each group on statin therapy. In patients with high LDL, the overall mean LDL was 131.5 ± 32.5 mg/dl with mean high HDL of 54.3 ± 13.0 mg/dl and low HDL of 33.2 ± 6.0 mg/dl. In patients with low LDL, the overall mean was 74.0 ± 17.3 mg/dl with mean high HDL of 53.4 ± 12.6 mg/dl and low HDL of 32.8 ± 6.1 mg/dl. Multivariate analysis revealed high HDL is protective against MACE, death, and TVR at 1 year in patients with high LDL and protective against death in patients with low LDL. (Table⇓)
Conclusion: High HDL levels are protective for cardiac events and associated with reduction of death within 1 year post DES implantation regardless of the LDL levels. Therapies targeted at raising HDL may yield additional therapeutic benefit to those that lower LDL in patients presenting for elective angioplasty.