Abstract
BackgroundIt is still unclear whether low high-density lipoprotein cholesterol (HDL-C) affects cardiovascular outcomes after acute myocardial infarction (AMI), especially in patients with diabetes mellitus.MethodsA total of 984 AMI patients with diabetes mellitus from the DIabetic Acute Myocardial InfarctiON Disease (DIAMOND) Korean multicenter registry were divided into two groups based on HDL-C level on admission: normal HDL-C group (HDL-C ≥ 40 mg/dL, n = 519) and low HDL-C group (HDL-C < 40 mg/dL, n = 465). The primary endpoint was 2-year major adverse cardiovascular events (MACE), defined as a composite of cardiac death, non-fatal myocardial infarction (MI), and target vessel revascularization (TVR).ResultsThe median follow-up duration was 730 days. The 2-year MACE rates were significantly higher in the low HDL-C group than in the normal HDL-C group (MACE, 7.44% vs. 3.49%, p = 0.006; cardiac death, 3.72% vs. 0.97%, p = 0.004; non-fatal MI, 1.75% vs. 1.55%, p = 0.806; TVR, 3.50% vs. 0.97%, p = 0.007). Kaplan-Meier analysis revealed that the low HDL-C group had a significantly higher incidence of MACE compared to the normal HDL-C group (log-rank p = 0.013). After adjusting for conventional risk factors, Cox proportional hazards analysis suggested that low HDL-C was an independent risk predictor for MACE (hazard ratio [HR] 3.075, 95% confidence interval [CI] 1.034-9.144, p = 0.043).ConclusionsIn patients with diabetes mellitus, low HDL-C remained an independent risk predictor for MACE after adjusting for multiple risk factors during 2-year follow-up of AMI.Trial registrationThis study was the sub-analysis of the prospective multi-center registry of DIAMOND (Diabetic acute myocardial infarction Disease) in Korea. This is the observational study supported by Bayer HealthCare, Korea. Study number is 15614. First patient first visit was 02 April 2010 and last patient last visit was 09 December 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s12944-016-0374-5) contains supplementary material, which is available to authorized users.
Highlights
It is still unclear whether low high-density lipoprotein cholesterol (HDL-C) affects cardiovascular outcomes after acute myocardial infarction (AMI), especially in patients with diabetes mellitus
We have investigated the prevalence of low HDL-C and its long-term clinical impact in diabetic patients after AMI
Kaplan-Meier analysis revealed that the low HDL-C group had a significantly higher incidence of Normal HDL p-value
Summary
It is still unclear whether low high-density lipoprotein cholesterol (HDL-C) affects cardiovascular outcomes after acute myocardial infarction (AMI), especially in patients with diabetes mellitus. Acute myocardial infarction (AMI) is a leading cause of mortality in patients with diabetes mellitus. Recent data revealed a 10–15% 1-year mortality rate after AMI in a diabetic population [1]. Korean data showed a higher mortality rate after AMI in diabetic patients compared to non-diabetic patients [2]. Previous primary prevention trials revealed that low high-density lipoprotein cholesterol (HDL-C) level is a significant risk factor for cardiovascular events in the general population [5, 6]. The Treating to New Targets (TNT) study revealed that approximately 15% of patients with diabetes mellitus have low HDL-C level [7]. The association between low HDL-C and coronary heart disease seemed to be stronger in the Asian population compared to non-Asians [11]
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