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Eur Heart J. 2015 Jan 1;36(1):22-30. doi: 10.1093/eurheartj/ehu264. Epub 2014 Jun 30.

HDL cholesterol subclasses, myocardial infarction, and mortality in secondary prevention: the Lipoprotein Investigators Collaborative.

Author information

1
Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, 600 N. Wolfe St, Carnegie 565-G, Baltimore, 21287 MD, USA smart100@jhmi.edu.
2
St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
3
Cardiovascular Department, Intermountain Medical Center, Murray, UT, USA.
4
Atherotech Diagnostics Laboratory, Birmingham, AL, USA.
5
Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, 600 N. Wolfe St, Carnegie 565-G, Baltimore, 21287 MD, USA.
6
Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, 600 N. Wolfe St, Carnegie 565-G, Baltimore, 21287 MD, USA Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, USA University of Illinois School of Medicine, Peoria, IL, USA.
7
St Luke's Mid-America Heart Institute, University of Missouri - Kansas, Kansas City, MO, USA.

Abstract

AIMS:

High-density lipoprotein (HDL) is highly heterogeneous and the link of its subclasses to prognosis remains controversial. We aimed to rigorously examine the associations of HDL subclasses with prognosis in secondary prevention.

METHODS AND RESULTS:

We collaboratively analysed data from two, complementary prospective cohorts: the TRIUMPH study of 2465 acute myocardial infarction patients, and the IHCS study of 2414 patients who underwent coronary angiography. All patients had baseline HDL subclassification by vertical-spin density gradient ultracentrifugation. Given non-linearity, we stratified by tertiles of HDL-C and its two major subclasses (HDL2-C, HDL3-C), then compared multivariable-adjusted hazard ratios for mortality and mortality/myocardial infarction. Patients were middle-aged to elderly (TRIUMPH: 58.2 ± 12.2 years; IHCS: 62.6 ± 12.6 years), and the majority were men (TRIUMPH: 68.0%; IHCS: 65.5%). IHCS had lower mean HDL-C levels (34.6 ± 10.1 mg/dL) compared with TRIUMPH (40 ± 10.6 mg/dL). HDL3-C accounted for >3/4 of HDL-C (mean HDL3-C/HDL-C 0.78 ± 0.05 in both cohorts). During 2 years of follow-up in TRIUMPH, 226 (9.2%) deaths occurred, while death/myocardial infarction occurred in 401 (16.6%) IHCS patients over 5 years. No independent associations with outcomes were observed for HDL-C or HDL2-C. In contrast, the lowest tertile of HDL3-C was independently associated with >50% higher risk in each cohort (TRIUMPH: with middle tertile as reference, fully adjusted HR for mortality of HDL3-C, 1.57; 95% CI, 1.13-2.18; IHCS: fully adjusted HR for mortality/myocardial infarction, 1.55; 95% CI, 1.20-2.00).

CONCLUSION:

In secondary prevention, increased risk for long-term hard clinical events is associated with low HDL3-C, but not HDL2-C or HDL-C, highlighting the potential value of subclassifying HDL-C.

KEYWORDS:

Acute myocardial infarction; Coronary heart disease; HDL subclasses; HDL2; HDL3; High-density lipoprotein cholesterol; Lipids; Mortality; Secondary prevention

PMID:
24980493
PMCID:
PMC4286318
DOI:
10.1093/eurheartj/ehu264
[Indexed for MEDLINE]
Free PMC Article

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