Low HDL-C Associated With Increased Mortality in Patients With NSTEMI

Low levels of HDL-C among patients with NSTEMI are common, and associated with severe multivessel coronary artery disease and higher in-hospital mortality. These findings were published online today in the American Journal of Cardiology.

The retrospective analysis looked at HDL-C levels among 98,276 patients with NSTEMI enrolled in the Acute Coronary Treatment and Intervention Outcomes Network Registry— Get With the Guidelines (ACTION-GWTG) guidelines. Patients were stratified into quartiles based on admission HDL-C levels (Q1 10-30 mg/dL; Q2: 30.01-36.9 mg/dL; Q3: 37-45 mg/dL; Q4: 45.1-100 mg/dL) and their clinical characteristics, coronary artery disease (CAD) severity and outcomes were analyzed.

Nearly one-half of patients had HDL-C levels lower than the median 36.9 mg/dL at admission. Those with low HDL-C tended to be younger, more often were men and had a greater comorbidity burden compared to those with higher levels. Low HDL-C also was associated with more severe multivessel disease on angiography and higher in-hospital mortality. Among the 26 percent of patients in the lowest HDL-C quartile, mortality was 16 percent higher (p<0.012).

“A majority of contemporary real-world patients admitted with NSTEMI had low levels of HDL-C at presentation, which were associated with a greater number of comorbid conditions … a greater risk of severe and extensive CAD at coronary angiography and a significant incremental inverse risk of death during the index hospitalization,” the investigators concluded. “In light of the typically short duration of hospitalization after admission for an uncomplicated acute MI in the United States [generally in the two- to four-day range], this signal of increased in-hospital mortality with very low levels of HDL-C is noteworthy.”

However, the investigators also caution that the study’s retrospective methodology is subject to biases and that there is still uncertainty regarding when to draw reliable samples of serum lipid levels. Finally, insulin resistance, C-reactive protein and other predictors were not recorded in the registry and were not included in the multivariate analysis.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Uncertainty, Coronary Artery Disease, Multivariate Analysis, C-Reactive Protein, Hospital Mortality, Coronary Angiography, Cardiology, Comorbidity, Insulin Resistance


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