The Effect of High-Density Lipoprotein on the Rheumatic Mitral Valve Calcification and Surgical Prognosis.

BACKGROUND

Rheumatic heart disease remains the most common valvular heart disease in Asia and often leads to severe calcification of the valve leaflets. However, the causes of calcification and the factors influencing the prognosis of surgical patients are not yet clearly understood.

OBJECTIVES

This study aimed to explore the impact of plasma high-density lipoprotein (HDL) levels on the formation of rheumatic mitral valve calcification and the surgical prognosis.

METHODS

This retrospective cohort study included 847 patients who underwent mitral valve surgery for rheumatic heart disease at the Beijing Anzhen Hospital from January 2016 to December 2022. Patients were divided into a high HDL group (n = 413) and a low HDL group (n = 434) based on preoperative HDL levels.

RESULTS

Among 847 surgical patients (median follow-up 44.1 months), Kaplan-Meier analysis revealed that the high HDL group had higher mid-term survival (P = 0.018) and lower major adverse cardiovascular events risk (P = 0.005). Multivariate Cox regression confirmed HDL as independent risk factor for major adverse cardiovascular events (HR: 0.370; 95% CI: 0.220-0.620; P < 0.001), whereas other traditional lipid markers, including low-density lipoprotein (HR: 0.82; 95% CI: 0.54-1.23; P = 0.328) and triglycerides (HR: 0.65; 95% CI: 0.38-1.10; P = 0.107), were not statistically significant. Logistic regression indicated HDL as a protective factor against mitral valve calcification (HR: 0.01; 95% CI: 0.000-0.300; P = 0.009). Restricted cubic splines indicated that Agatston scores decreased with rising HDL when <1.3 mmol/L (P for nonlinear = 0.05; P for overall = 0.014).

CONCLUSIONS

The findings suggest that higher preoperative HDL levels could be correlated with lighter valve calcification, enhanced mid-term survival rates, and a decreased risk of cardiovascular events.