HDLc levels have a protective effect for in-hospital mortality in Non-STEMI but not in STEMI patients

Abstract

Abstract Background High-density lipoprotein cholesterol (HDLc) has been associated to lower myocardial infarction size although it is not considered a primary target in cardiovascular prevention or as treatment target in patients with cardiovascular disease. The role of HDLc on in-hospital mortality in acute coronary syndrome (ACS) patients could be influenced by many variables. Methods We performed and observational and cross-sectional analysis of all patients admitted for an ACS in 2 tertiary hospitals in Spain between 2006 and 2016. HDL was measured in the first 24 of the admission in the first overnight fasting state. Results We included 8,684 patients, mean (standard deviation) age 66.88 (12.90), 27.5% women, mean GRACE score 143.13 (40.27), and 35.09% admitted for ST-elevation myocardial infarction (STEMI). Mean HDLc levels were 35.90 (13.64) mg/dL in whole cohort and were significantly lower in patients presenting as non-STEMI (35.53±13.62 vs. 36.55± 13.65 mg/dL), those with GRACE score <140 (35.09±13.00 vs. 36.78±14.24 mg/dL) and women (34.28±12.81 vs. 40.21±14.80 mg/dL) but not in patients who died or not (p=0.43). From these variables, we observed a significant interaction of HDLc levels and STEMI presentation (p=0.03) for in-hospital mortality risk and, thus, results were analyzed separately. After natural logarithm transformation, in-hospital mortality risk had a "U-shaped" distribution in STEMI patients compared to the linear trend in Non-STEMI patients (figure 1). Multivariate analysis, adjusted by age, gender, risk factors, hemoglobin, revascularization and GRACE score, verified the interaction and the protective effect of HDLc in Non-STEMI patients (OR: 0.48 95% CI 0.28-0.80; p=0.005) but not in STEMI patients (OR: 0.96 95% CI 0.55-1.67; p=0.887) (figure 2). Conclusions Clinical presentation of STEMI vs. non-STEMI modifies the effect of HDLc on in-hospital mortality. HDLc might have a protective effect in patients presenting with non-STEMI only.