Abstract 17203: Prevalence of Low Levels of High-Density Lipoprotein Cholesterol (HDL-C) at Presentation in Acute Coronary Syndromes (ACS) and its Relation to In-Hospital Mortality: Results from the NCDR®
Background: Despite profound advances in medical and procedural therapy, significant residual risk persists for in-hospital mortality among patients admitted with ACS. Low HDL-C, a known independent risk predictor for increased cardiovascular events, may modulate risk in ACS patients.
Methods: We evaluated baseline HDL-C levels among 98,276 non-ST-elevation MI patients from the NCDR ACTION-GWTG registry enrolled from 490 U.S. hospitals between January 2007 and December 2010. Clinical characteristics, treatments, and in-hospital outcomes were analyzed by quartiles of HDL-C measured during hospitalization. Using the highest quartile as referent, hazard ratios were obtained for in-hospital mortality using multivariable risk adjustment.
Results: Almost half of the patients in the examined cohort had presentation HDL-C levels lower than or equal to the median (36.9 mg/dL). Patients in lower HDL-C quartiles were younger, more often male, white, smokers, obese, diabetic and had greater rates of prior MI, PCI, CABG and revascularization (P <0.0001) compared to those in higher HDL-C quartiles. Use of medical therapy (aspirin, clopidogrel, beta-blockers, ACE inhibitors or ARBs, statins and other lipid-lowering agents) at home was greater among patients with lower HDL-C (P = 0.0002 for statins, <0.0001 for others). Significantly greater in-hospital mortality was noted with decreasing HDL-C quartiles in the overall cohort. Among patients in the lowest HDL-C quartile, a 16% greater risk of in-hospital death was noted compared to their counterparts in the highest HDL-C quartile (P = 0.0073) (Figure 1).
Conclusion: Low levels of HDL-C at presentation was common among this national contemporary “real-world” cohort of patients admitted with non-ST-elevation ACS. Very low HDL-C levels (≤ 30 mg/dL) at presentation represented an adverse prognostic factor and was associated with higher in-hospital mortality.
- © 2011 by American Heart Association, Inc.