Elsevier

Atherosclerosis

Volume 263, August 2017, Pages 104-111
Atherosclerosis

High-density lipoprotein cholesterol levels are associated with coronary severity but not with outcomes in new-onset patients with stable coronary artery disease

https://doi.org/10.1016/j.atherosclerosis.2017.06.013Get rights and content

Highlights

  • HDL-C was associated with severity but not with outcomes of stable, new-onset CAD.

  • The relation of HDL-C to CAD was not modified by gender, age and LDL-C levels.

  • This was a relative large cohort study in Chinese patients.

Abstract

Background and aims

The atheroprotective role of high-density lipoprotein cholesterol (HDL-C) levels in coronary artery disease (CAD) remains controversial. This study sought to reappraise the value of HDL-C in predicting the severity and outcomes of new-onset patients with stable CAD in Chinese populations.

Methods

A total of 4205 new-onset patients with stable CAD who received coronary angiography were enrolled to analyze the relation of HDL-C to coronary severity and major adverse cardiovascular events (MACEs). Coronary severity was evaluated by Gensini scoring system. The MACEs included all-cause death, non-fatal myocardial infarction, stroke, unplanned revascularization and hospitalized unstable angina.

Results

Significantly, HDL-C levels were negatively associated with coronary severity (p < 0.001). During an average of 27.32-month follow-up, 341 (8.12%) MACEs occurred. There was no significant difference of HDL-C levels between events group and non-events group. Furthermore, both Kaplan-Meier and Cox regression analyses found no relationship between HDL-C and cardiovascular outcomes (p > 0.05).

Conclusions

Plasma HDL-C levels appeared to be a predicator for coronary severity, but it is not associated with clinical outcomes in new-onset, Chinese patients with stable CAD.

Introduction

Coronary artery disease (CAD) remains one of the major causes of human mortality worldwide, despite considerable attention to cardiovascular (CV) risk prevention [1]. The presence of dyslipidemia is closely related to increased CV morbidity and mortality, in particularly, high levels of low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) have always been regarded as key factors in atherogenesis and prevalence of CAD [2]. However, recent studies have indicated that despite achieving therapeutic goal for LDL-C levels with statins, high residual risk still existed in patients with CAD [1]. Therefore, attention has been focused on low levels of plasma high-density lipoprotein (HDL). However, the role of HDL particles, as measured by HDL cholesterol (HDL-C) levels in circulation, in atherosclerosis and CAD remains controversial. Early epidemiological studies consistently demonstrated that HDL-C levels were inversely associated with the prevalence, severity and outcomes of CAD [3], [4], [5], but it was not confirmed in the statin era [2], [6], [7]. Meanwhile, several current clinical trials failed to demonstrate additional benefits of raising HDL-C levels beyond those obtained by lowering LDL-C with standard statin therapy [2].

Furthermore, there are a great deal of differences between Western and Chinese populations, including environment, food habits, genetics, and drug response, which may explain the differences in HDL-C levels and other lipid profiles observed in the two populations. Therefore, it is likely that the role of each lipid component in the risk and prognosis of CAD in the Chinese people may also be different from their Western counterparts [8]. It's well known that HDL-C levels in different genders or various ages are also different [9]. Additionally, the clinical interaction between HDL-C and LDL-C levels remains unclear, with some studies suggesting a continuing predictive role of HDL-C for CAD regardless of achieved LDL-C levels, whereas others supporting that HDL-C and CAD may not be relevant when LDL-C is reduced to very low levels, especially when a potent statin therapy is used [10].

Given the deficiency of detailed and comprehensive studies of the association between HDL-C levels and CAD in a large Chinese population, we conducted a prospective, relative large cohort study in Chinese populations to reappraise the value of HDL-C levels to the severity and prognosis of stable CAD, with the influence of gender, age and LDL-C levels taken into account.

Section snippets

Study design and population

The study complied with the Declaration of Helsinki and was approved by the hospital's ethical review board (FuWai Hospital & National Center for Cardiovascular Diseases, Beijing, China). Each participant provided written, informed consent before enrollment.

To create the study cohort, 6788 consecutive Chinese patients, who received coronary angiography (CAG) because of angina-like chest pain and/or positive treadmill exercise test and/or significant stenosis indicated by coronary computed

Baseline characteristics

The baseline demographics and clinical characteristics of the study population are shown in Table 1. Overall, the enrolled subjects were classified into three groups according to the tertiles of GS (<18 in group 1; 18–40 in group 2; ≥40 in group 3). There existed significant differences in HDL-C levels among the three groups (p < 0.001). Meanwhile, the GS was positively related to age, male gender, traditional risk factors of hypertension, diabetes mellitus (DM) and smoking, and family history

Discussion

In this prospective study on new-onset patients undergoing CAG, we, interestingly, found that baseline plasma HDL-C levels were inversely associated with coronary severity, but not with future CV outcomes in a Chinese cohort with stable CAD. More importantly, despite the negative correlation between HDL-C levels and GS was not statistically significant in females, this discordance of relationship between plasma HDL-C and CAD remained consistent regardless of age and various LDL-C levels in the

Conflict of interest

The authors declared they do not have anything to disclose regarding conflict of interest with respect to this manuscript.

Financial support

This work was partially supported by the Capital Health Development Fund (201614035) and CAMS Major Collaborative Innovation Project (2016-I2M-1-011) awarded to Dr. Jian-Jun Li, MD, PhD.

Author contributions

Jian-Jun Li and Hui-Hui Liu were in charge of the design of this study; Ying Gao, Ping Qing, Sha Li, Xi Zhao, Yan Zhang, Di Sun, Geng Liu and Qian Dong carried out the experiments; Yuan-Lin Guo, Na-Qiong Wu and Cheng-Gang Zhu mainly analyzed the experimental data and results. Hui-Hui Liu and Jian-Jun Li wrote the manuscript.

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