Low HDL-cholesterol is a strong independent risk marker in non ST-segment elevation acute coronary syndromes

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Abstract

Objetive

To analyze the link between usual lipid parameters with myocardial necrosis or inflammation markers and short- and long-term prognosis in patients with non ST-segment elevation acute coronary syndrome (ACS). 

Material and methods

Prospective cohort study of 106 consecutive patients admitted with non-ST elevation ACS. Baseline clinical and ECG data were recorded and blood samples were collected for: a) Total cholesterol LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), and triglycerides (TG) ≤  12 hours from admission. b) TnT 8-24 hours from last chest pain episode. c) C-reactive proteine (CRP) 8-24 hours and 48-72 hours from last chest pain episode. End point (EP) was death and/or MI at the end of a follow-up of 371 ± 201 days (maximum 830). We also analized the correlation between lipids leves and CRP or TnT.

Results

There was a significant correlation between CRP leve;s with HDL-C (r=0,36; p=0,002) and TG (r=0,27; p < 0,05). No association was found between TnT and lipid levels. Lower HDL-C levels were associated with worse prognosis. In a multivariate analysis (Cox regression model) HDL-C < 35 mg/dl was the strongest independent predictor of EP. 

Conclusion

Low HDL-C levels in non-ST elevation acute coronary syndrome are associated with elevated CRP, and constitute an strong independent predictor for short- and long- term serious events. Further studies are needed to determine the precise role of lipid levels in this patients and eventually to include them in risk stratification.