TY - JOUR
T1 - HDL cholesterol subclasses, myocardial infarction, and mortality in secondary prevention
T2 - The lipoprotein investigators collaborative
AU - Martin, Seth S.
AU - Khokhar, Arif A.
AU - May, Heidi T.
AU - Kulkarni, Krishnaji R.
AU - Blaha, Michael J.
AU - Joshi, Parag H.
AU - Toth, Peter P.
AU - Muhlestein, Joseph B.
AU - Anderson, Jeffrey L.
AU - Knight, Stacey
AU - Li, Yan
AU - Spertus, John A.
AU - Jones, Steven R.
N1 - Funding Information:
This work was supported by the National Heart, Lung, and Blood Institute (P50 HL 077113). S.S.M. and P.H.J. are supported by the Pollin Cardiovascular Prevention Fellowship and by NIH training grants (T32HL07024 and T32HL007227, respectively). S.S.M. is also supported by the Marie-Josée and Henry R. Kravis endowed fellowship.
Publisher Copyright:
© 2014 Published on behalf of the European Society of Cardiology.
PY - 2015/1/1
Y1 - 2015/1/1
N2 - 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.
AB - 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.
KW - Acute myocardial infarction
KW - Coronary heart disease
KW - HDL subclasses
KW - HDL2
KW - HDL3
KW - High-density lipoprotein cholesterol
KW - Lipids
KW - Mortality
KW - Secondary prevention
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U2 - 10.1093/eurheartj/ehu264
DO - 10.1093/eurheartj/ehu264
M3 - Article
C2 - 24980493
AN - SCOPUS:84926389606
SN - 0195-668X
VL - 36
SP - 22
EP - 30
JO - European Heart Journal
JF - European Heart Journal
IS - 1
ER -