High-density lipoprotein cholesterol, coronary artery disease, and cardiovascular mortality.
Guenther Silbernagel,Ben Schöttker,Sebastian Appelbaum,Hubert Scharnagl,Marcus E. Kleber,Tanja B. Grammer,Andreas Ritsch,Ute Mons,Bernd Holleczek,Georg Goliasch,Alexander Niessner,Bernhard O. Boehm,Bernhard O. Boehm,Renate B. Schnabel,Hermann Brenner,Stefan Blankenberg,Ulf Landmesser,Winfried März,Winfried März +18 more
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TLDR
The inverse relationship of HDL cholesterol with cardiovascular mortality is weakened in patients with CAD, and the usefulness of considering HDL cholesterol for cardiovascular risk stratification seems limited in such patients.Abstract:
Aims High-density lipoprotein (HDL) cholesterol is a strong predictor of cardiovascular mortality. This work aimed to investigate whether the presence of coronary artery disease (CAD) impacts on its predictive value.
Methods and results We studied 3141 participants (2191 males, 950 females) of the LUdwigshafen RIsk and Cardiovascular health (LURIC) study. They had a mean ± standard deviation age of 62.6 ± 10.6 years, body mass index of 27.5 ± 4.1 kg/m², and HDL cholesterol of 38.9 ± 10.8 mg/dL. The cohort consisted of 699 people without CAD, 1515 patients with stable CAD, and 927 patients with unstable CAD. The participants were prospectively followed for cardiovascular mortality over a median (inter-quartile range) period of 9.9 (8.7–10.7) years. A total of 590 participants died from cardiovascular diseases. High-density lipoprotein cholesterol by tertiles was inversely related to cardiovascular mortality in the entire cohort ( P = 0.009). There was significant interaction between HDL cholesterol and CAD in predicting the outcome ( P = 0.007). In stratified analyses, HDL cholesterol was strongly associated with cardiovascular mortality in people without CAD [3rd vs. 1st tertile: HR (95% CI) = 0.37 (0.18–0.74), P = 0.005], but not in patients with stable [3rd vs. 1st tertile: HR (95% CI) = 0.81 (0.61–1.09), P = 0.159] and unstable [3rd vs. 1st tertile: HR (95% CI) = 0.91 (0.59–1.41), P = 0.675] CAD. These results were replicated by analyses in 3413 participants of the Athero Gene cohort and 5738 participants of the ESTHER cohort, and by a meta-analysis comprising all three cohorts.
Conclusion The inverse relationship of HDL cholesterol with cardiovascular mortality is weakened in patients with CAD. The usefulness of considering HDL cholesterol for cardiovascular risk stratification seems limited in such patients.read more
Citations
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The role of vascular biomarkers for primary and secondary prevention. A position paper from the European Society of Cardiology Working Group on peripheral circulation: Endorsed by the Association for Research into Arterial Structure and Physiology (ARTERY) Society.
Charalambos Vlachopoulos,Panagiotis Xaplanteris,Victor Aboyans,Marianne Brodmann,Renata Cifkova,Francesco Cosentino,Marco De Carlo,Augusto Gallino,Ulf Landmesser,Stéphane Laurent,John Lekakis,Dimitri P. Mikhailidis,Katerina K. Naka,Athanasios Protogerou,Damiano Rizzoni,Arno Schmidt-Trucksäss,Luc M. Van Bortel,Thomas Weber,Akira Yamashina,Reuven Zimlichman,Pierre Boutouyrie,John R. Cockcroft,Michael F. O'Rourke,Jeong Bae Park,Giuseppe Schillaci,Henrik Sillesen,Raymond R. Townsend +26 more
TL;DR: The role of peripheral (i.e. not related to coronary circulation) noninvasive vascular biomarkers for primary and secondary cardiovascular disease prevention is scrutinized and it is still unclear whether a specific vascular biomarker is overly superior.
Journal ArticleDOI
High-Density Lipoprotein Cholesterol and Cause-Specific Mortality in Individuals Without Previous Cardiovascular Conditions: The CANHEART Study.
Dennis T. Ko,David A. Alter,Helen Guo,Maria Koh,Geoffrey Lau,Peter C. Austin,Gillian L. Booth,William Hogg,Cynthia A. Jackevicius,Douglas S. Lee,Harindra C. Wijeysundera,John T. Wilkins,Jack V. Tu +12 more
TL;DR: HDL-C level is unlikely to represent a CV-specific risk factor given similarities in its associations with non-CV outcomes, and complex associations exist between HDL-C levels and sociodemographic, lifestyle, comorbidity factors, and mortality.
Journal ArticleDOI
Effects of the high-density lipoprotein mimetic agent CER-001 on coronary atherosclerosis in patients with acute coronary syndromes: a randomized trial
Jean-Claude Tardif,Jean-Claude Tardif,Christie M. Ballantyne,Philip J. Barter,Jean-Louis Dasseux,Zahi A. Fayad,Marie-Claude Guertin,Marie-Claude Guertin,John J. P. Kastelein,Constance Keyserling,Heather Klepp,Wolfgang Koenig,Philippe L. L’Allier,Philippe L. L’Allier,Jacques Lespérance,Jacques Lespérance,Thomas F. Lüscher,John F. Paolini,Ahmed Tawakol,David D. Waters +19 more
TL;DR: CER-001 infusions did not reduce coronary atherosclerosis on IVUS and QCA when compared with placebo, and whether C ER-001 administered in other regimens or to other populations could favourably affect atheros sclerosis must await further study.
Journal ArticleDOI
HDL cholesterol: reappraisal of its clinical relevance.
Winfried März,Winfried März,Winfried März,Marcus E. Kleber,Marcus E. Kleber,Hubert Scharnagl,T Speer,Stephen Zewinger,Andreas Ritsch,Klaus G. Parhofer,Arnold von Eckardstein,Ulf Landmesser,Ulrich Laufs +12 more
TL;DR: In contrast to LDL cholesterol (LDL-C), HDL-C correlates with cardiovascular risk only in healthy individuals and is currently not a valid target for drug therapy.
Journal ArticleDOI
HDL cholesterol subclasses, myocardial infarction, and mortality in secondary prevention: the lipoprotein investigators collaborative
Seth S. Martin,Arif A Khokhar,Heidi T May,Krishnaji R. Kulkarni,Michael J. Blaha,Parag H. Joshi,Peter P. Toth,Peter P. Toth,Joseph B. Muhlestein,Jeffrey L. Anderson,Stacey Knight,Yan Li,John A. Spertus,Steven R. Jones +13 more
TL;DR: In secondary prevention, increased risk for long-term hard clinical events is associated with low HDL3-C, but not HDL2-C or HDL- C, highlighting the potential value of subclassifying HDL-C.
References
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