Very low high-density lipoprotein-cholesterol and long-term mortality

Natalie Kappo (Essen)1, O. Babinets (Essen)1, F. Al-Rashid (Essen)1, M. Totzeck (Essen)1, T. Rassaf (Essen)1, A.-A. Mahabadi (Essen)1, I. Dykun (Essen)1

1Universitätsklinikum Essen Klinik für Kardiologie und Angiologie Essen, Deutschland


Background: High-density lipoprotein-cholesterol (HDL-C) has anti-atherogenic, anti-inflammatory, antioxidative, anti-apoptotic, and vasodilatory properties. A U-shaped association between HDL-C and outcome has been described in patients with existing coronary artery disease with both low and high HDL-levels being linked to increased risk.

Purpose: We tested the interaction between HDL-C and HbA1c-levels with long-term mortality in patients with known coronary artery disease.

Methods: The present analysis is based on the longitudinal ECAD registry of consecutive patients undergoing percutaneous coronary intervention at the West German Heart and Vascular Center between 2004 and 2019. HDL-C and HbA1c was quantified at hospital admission using standardized enzymatic methods. The incidence of death due to any cause was evaluated during follow-up. We report frequency of incident mortality in subgroups, stratified by HbA1c and HDL-levels.

Results: Among 4088 patients, mean age was 66.4±11.4 years and 77.5% were men. Mean HDL-C was 46.6 ± 13.9 mg/dL, mean HbA1c was 6.27±1.18 mg/dL. During a median follow-up 2.72 (0.59; 6.08) years, 494 patients (12.1%) died. In patients with HbA1c < 6%, mortality rate decreased with increasing quintile of HDL-Levels (22.3, 8.6, 11.0, 9.1, 6.7% for 1st to 5th quintile, respectively). In contrast, for patients with HbA1c ≥ 7%, both high and low HDL-levels were linked to higher mortality risk (24.8, 17.7, 10.6, 9.30, 18.5% for 1st to 5th quintile, respectively).

Conclusions: In a large longitudinal registry cohort of patients undergoing invasive coronary angiography, high HDL-levels only associate with increased mortality in case of elevated HbA1c. The interaction of different metabolic parameters needs to be taken into account when evaluating individual patient’s risk.
Diese Seite teilen