ATLANTA — Low baseline HDL-cholesterol levels in patients who receive a drug-eluting stent for acute coronary syndrome appears to be an independent risk factor for adverse short- and long-term clinical outcomes, Dr. Roswitha M. Wolfram said at the annual meeting of the American College of Cardiology.
The most likely hypothesis to explain this finding is that HDL cholesterol plays an important role in dampening the inflammatory response to percutaneous intervention, according to Dr. Wolfram of Washington Hospital Center.
She presented an observational study in 1,032 consecutive patients who got a drug-eluting stent when they presented at the center with acute coronary syndrome. Of them, 550 had low baseline HDL levels, defined as less than 40 mg/dL in men or 45 mg/dL in women. The other 482 were categorized as having high HDL. Ninety-eight percent of patients in both groups were on statin therapy during follow-up.
The 30-day rates of mortality and a composite end point consisting of target lesion revascularization and/or major cardiac adverse events were significantly higher in stented patients with low HDL. The same was true during days 31–365. (see box.)
Patients with low baseline HDL were more likely to be diabetic, had higher body mass index and triglyceride levels, and had lower total cholesterol than those with high HDL. Upon adjusting for these potential confounders in a multivariate analysis, two independent predictors of death at 1 year emerged: a history of diabetes, which conferred a 3.8-fold increased risk, and a high baseline HDL, which was associated with a 70% relative risk reduction.
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