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Clinical evidence for increased Cardiovascular mortality and late adverse events with low HDL levels
Session:
Painel 8 -Doença Coronária 6
Speaker:
Andreia Pereira
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.2 Coronary Artery Disease – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Andreia Pereira; Marina Santos; Margarida Temtem; Flávio Mendonça; Adriano Sousa; Joel Monteiro; Ana Célia Sousa; Sónia Freitas; Eva Henriques; Ilídio Ornelas; A. Drumond de Freitas; Roberto Palma dos Reis; Maria Isabel Mendonça
Abstract
<p>The major cause of CAD is known to be atherosclerosis, and reduction of low-density lipoprotein (LDL) has proven to reduce major cardiovascular events risk in coronary patients. There has been no consensus as to whether subjects with high serum HDL-C levels are resistant to atherosclerosis.<br /> Objective:<br /> To evaluate cardiovascular mortality (CV Mortality) and major adverse events (MACE) in a population with proven angiographic coronary disease according to concentration levels of HDL.<br /> Materials and Methods:<br /> 1676 patients selected from GENEMACOR study population, with at least one > 75% coronary stenosis by angiography divided according to the HDL level quartiles (1st quartile HDL <35.3 mg/dL; 2nd quartile HDL 35.3 – 42 mg/dL; 3rd quartile HDL 42 – 49 mg/dL; 4th quartile HDL >49 mg/dL). Population of the 1st (n=420, median age 53.2±7.9 years, 85.7% male) and 4rd quartiles (n=405 patients, 53.4± 8.0 years, 71.4% male) were prospectively followed up of mean 5.0±4.2 years (1.96 - 7.57). CV Mortality, and MACE events were adjudicated during follow up. Survival Kaplan Meyer curves were plotted according to HDL quartiles. Cox Regression analysis was derived.<br /> RESULTS: In our population, 298 MACES (170; 1º quartile vs 128 events 4º quartile) and 106 CV deaths (70, 1º quartile vs 36 4º quartile) were adjudicated. HDL was lower in patients with CV mortality (66% vs 34%, p=0.001) and lower in patient with MACE occurrence (57% vs 43%, p=0.008). First quartile of HDL translated with higher CV mortality (OR 2.050, 95% CI 1.337-3.144, p=0.001) and higher occurrence of MACE (OR of 1.472, 95% CI 1.105-1.959, p=0.008). Survival Kaplan Meyer curves confirmed increased survival and reduced MACES in higher vs lower quartile of HDL levels.<br /> Conclusion:<br /> In our population a lower level of HDL was associated with adverse prognosis and increased cardiovascular mortality. To date, there are no secure and effective drugs available for the increase of HDL functionality, so new therapeutic targets in lipid metabolism might be approached to efficiently reduce cardiovascular risk.<br /> </p>
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