HDL-C levels and revascularization procedures in coronary heart disease patients treated with statins to target LDL-C levels.

BACKGROUND

A low level of high-density lipoprotein cholesterol (HDL-C) is a strong predictor for cardiovascular disease morbidity and mortality at all low-density lipoprotein cholesterol (LDL-C) concentrations.

HYPOTHESIS: We evaluated this association in routine clinical practice among statin-treated coronary heart disease patients who achieved LDL-C target levels. This association also exists in routine clinical practice.

METHODS

A retrospective dynamic cohort included all male coronary heart disease patients of the Sharon-Shomron district, Clalit Health Services, Israel, with LDL-C levels < 100 mg/dL and who were receiving statins (≥ 6 purchases/y) from January 1998 to June 2008. Data were collected on demographic variables; coexistence of hypertension, diabetes mellitus, and peripheral vascular diseases; details of revascularization procedures; and lipid levels. The outcome variable was revascularization procedure, by either percutaneous intervention or coronary artery bypass graft.

RESULTS

The study group of 909 male patients was stratified into quintiles, based on mean HDL-C levels: Q1 (n = 179): ≤ 26.4 mg/dL; Q2 (n = 190): 26.4-≤ 30.0 mg/dL; Q3 (n = 191): > 30.0-≤ 34.0 mg/dL; Q4 (n = 186): > 34.0-≤ 41.0 mg/dL; Q5 (n = 163): > 41.0 mg/dL. During the study period, 307 (33.8%) of the cohort required ≥ 1 revascularization procedure. Those in the highest quintile underwent significantly fewer procedures (40.8% for Q1 vs 16.6% for Q5, P<0.001). This significant effect of the highest HDL-C quintile was not influenced by any variable.

CONCLUSIONS

The protective effect of high HDL-C levels, regardless of other risk factors, in preventing revascularization procedures was confirmed in the routine clinical practice among statin-treated CHD patients who reached LDL-C level < 100 mg/dL. Possible additional benefits of using agents to raise HDL-C levels should be investigated.