Abstract 17972: Low Levels of High-Density Lipoprotein Cholesterol (HDL-C) at Presentation in Acute Coronary Syndromes (ACS) and its Relation to Angiographically-Observed Atherosclerotic Burden: Results from the NCDR®
Background: Although low levels of HDL-C are a known independent risk predictor in stable cardiovascular disease, limited data exist regarding its association with atherosclerotic burden as observed by coronary angiography in patients admitted with ACS.
Methods: We evaluated HDL-C levels among 83,110 non-ST-elevation MI patients from the NCDR ACTION-GWTG registry who underwent diagnostic angiography at 461 U.S. hospitals from January 2007 through December 2010. Clinical and angiographic characteristics were analyzed by quartiles of HDL-C measured during hospitalization. Multivariable models were created to determine the risk of severe CAD (left main or 3 vessel disease) vs 1-2 vessel CAD in each quartile, using the highest quartile as referent.
Results: Over half of the patients in the examined cohort had presentation HDL-C levels lower than or equal to median (36.9 mg/dL). Patients in lower HDL-C quartiles were younger, more often male, white, smokers, obese, diabetic, hypertensive and had greater rates of prior MI, PCI, CABG and revascularization (P = 0.04 for hypertension, <0.0001 for others) compared to those in higher HDL-C quartiles. Use of medical therapy (aspirin, clopidogrel, beta-blocker, ACE inhibitor or ARB, statin and other lipid-lowering agents) at home was greater among patients with lower HDL-C (P = 0.02 for statin, <0.0001 for others). Individuals in lower HDL-C quartiles had a greater extent of angiographic stenoses and higher risk of severe CAD. This association persisted despite multivariable adjustment, with patients in the lowest HDL-C quartile demonstrating a 28% greater risk of severe CAD compared with their counterparts in the highest HDL-C quartile (Table 1).
Conclusion: Among patients undergoing diagnostic angiography for non-ST-elevation ACS, low level of HDL-C at presentation was common and was independently associated with greater angiographically-observed atherosclerotic burden, including more left main or 3 vessel CAD.
- © 2011 by American Heart Association, Inc.