Relation of Admission High-Density Lipoprotein Cholesterol Level and In-Hospital Mortality in Patients With Acute Non-ST Segment Elevation Myocardial Infarction (from the National Cardiovascular Data Registry)

      Despite recent therapeutic advances, significant residual risk for in-hospital mortality persists among patients admitted with acute myocardial infarction (MI). Low levels of high-density lipoprotein cholesterol (HDL-C), a known independent predictor of increased cardiovascular events, may be an important modulator of heightened risk after acute MI. We evaluated admission HDL-C levels among 98,276 patients with non-ST elevation myocardial infarction with acute MI from the Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With the Guidelines (ACTION Registry–GWTG) program who were enrolled from 490 United States hospitals from January 2007 to December 2010. Clinical characteristics, treatments, atherosclerotic burden, and in-hospital outcomes were analyzed by quartiles of admission HDL-C (Q1: 10 to 30 mg/dl; Q2: 30.1 to 36.9 mg/dl; Q3: 37 to 45 mg/dl; and Q4: 45.1 to 100 mg/dl). Logistic regression was used to explore the relation among HDL-C quartiles, coronary artery disease severity, and in-hospital mortality. Almost half of the patients with acute MI had low admission levels of HDL-C (less than the median 36.9 mg/dl). Such patients were younger, more often men, white, obese, diabetic, smokers, and had higher rates of previous cardiovascular events. After multivariate adjustment, patients with low HDL-C levels had greater extent of severe angiographic multivessel coronary narrowings and higher mortality. Among the 26% of patients in the lowest HDL-C quartile (≤30 mg/dl), there was a 16% greater risk of in-hospital mortality compared with patients in the highest HDL-C quartile (p = 0.012). In conclusion, low levels of HDL-C were common in patients admitted with acute MI and were associated with more extensive angiographic coronary disease. Very low levels of admission HDL-C were observed in one-quarter of patients and associated with significantly higher in-hospital mortality.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Jafri H.
        • Alsheikh-Ali A.A.
        • Karas R.H.
        Meta-analysis: statin therapy does not alter the association between low levels of high-density lipoprotein cholesterol and increased cardiovascular risk.
        Ann Intern Med. 2010; 153: 800-808
        • Castelli W.P.
        • Garrison R.J.
        • Wilson P.W.
        • Abbott R.D.
        • Kalousdian S.
        • Kannel W.B.
        Incidence of coronary heart disease and lipoprotein cholesterol levels. The Framingham Study.
        JAMA. 1986; 256: 2835-2838
        • Assmann G.
        • Schulte H.
        • von Eckardstein A.
        • Huang Y.
        High-density lipoprotein cholesterol as a predictor of coronary heart disease risk. The PROCAM experience and pathophysiological implications for reverse cholesterol transport.
        Atherosclerosis. 1996; 124: S11-S20
        • Choi B.G.
        • Vilahur G.
        • Yadegar D.
        • Viles-Gonzalez J.F.
        • Badimon J.J.
        The role of high-density lipoprotein cholesterol in the prevention and possible treatment of cardiovascular disease.
        Curr Mol Med. 2006; 6: 571-587
        • Ray K.K.
        • Cannon C.P.
        • Ganz P.
        Beyond lipid lowering: what have we learned about the benefits of statins from the acute coronary syndromes trials?.
        Am J Cardiol. 2006; 98: S18-S25
        • Peterson E.D.
        • Roe M.T.
        • Rumsfeld J.S.
        • Shaw R.E.
        • Brindis R.G.
        • Fonarow G.C.
        • Cannon C.P.
        A call to ACTION (Acute Coronary Treatment and Intervention Outcomes Network): a national effort to promote timely clinical feedback and support continuous quality improvement for acute myocardial infarction.
        Circ Cardiovasc Qual Outcomes. 2009; 2: 491-499
        • Zeger S.
        • Liang K.
        Longitudinal data analysis for discrete and continuous outcomes.
        Biometrics. 1986; 42: 121-130
        • Chin C.T.
        • Chen A.Y.
        • Wang T.Y.
        • Alexander K.P.
        • Mathews R.
        • Rumsfeld J.S.
        • Cannon C.P.
        • Fonarow G.C.
        • Peterson E.D.
        • Roe M.T.
        Risk adjustment for in-hospital mortality of contemporary patients with acute myocardial infarction: the acute coronary treatment and intervention outcomes network (ACTION) registry-get with the guidelines (GWTG) acute myocardial infarction mortality model and risk score.
        Am Heart J. 2011; 161: 113-122
        • Sachdeva A.
        • Cannon C.P.
        • Deedwania P.C.
        • Labresh K.A.
        • Smith Jr., S.C.
        • Dai D.
        • Hernandez A.
        • Fonarow G.C.
        Lipid levels in patients hospitalized with coronary artery disease: an analysis of 136,905 hospitalizations in Get With The Guidelines.
        Am Heart J. 2009; 157: 111-117
        • Grundy S.M.
        • Cleeman J.I.
        • Merz C.N.
        • Brewer Jr., H.B.
        • Clark L.T.
        • Hunninghake D.B.
        • Pasternak R.C.
        • Smith Jr., S.C.
        • Stone N.J.
        National Heart, Lung, and Blood Institute; American College of Cardiology Foundation; American Heart Association. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines.
        Circulation. 2004; 110: 227-239
        • Roe M.T.
        • Ou F.S.
        • Alexander K.P.
        • Newby L.K.
        • Foody J.M.
        • Gibler W.B.
        • Boden W.E.
        • Ohman E.M.
        • Smith Jr., S.C.
        • Peterson E.D.
        Patterns and prognostic implications of low high-density lipoprotein levels in patients with non-ST-segment elevation acute coronary syndromes.
        Eur Heart J. 2008; 29: 2480-2488
        • Sattler K.J.
        • Herrmann J.
        • Yün S.
        • Lehmann N.
        • Wang Z.
        • Heusch G.
        • Sack S.
        • Erbel R.
        • Levkau B.
        High high-density lipoprotein-cholesterol reduces risk and extent of percutaneous coronary intervention-related myocardial infarction and improves long-term outcome in patients undergoing elective percutaneous coronary intervention.
        Eur Heart J. 2009; 30: 1894-1902
        • Alwaili K.
        • Bailey D.
        • Awan Z.
        • Bailey S.D.
        • Ruel I.
        • Hafiane A.
        • Krimbou L.
        • Laboissiere S.
        • Genest J.
        The HDL proteome in acute coronary syndromes shifts to an inflammatory profile.
        Biochim Biophys Acta. 2012; 1821: 405-415
        • Fyfe T.
        • Baxter R.H.
        • Cochran K.M.
        • Booth E.M.
        Plasma-lipid changes after myocardial infarction.
        Lancet. 1971; 2: 997-1001
        • Ryder R.E.
        • Hayes T.M.
        • Mulligan I.P.
        • Kingswood J.C.
        • Williams S.
        • Owens D.R.
        How soon after myocardial infarction should plasma lipid values be assessed?.
        BMJ. 1984; 289: 1651-1653
        • Pitt B.
        • Loscalzo J.
        • Yas J.
        • Raichlen J.S.
        Lipid levels after acute coronary syndromes.
        J Am Coll Cardiol. 2008; 51: 1440-1445
        • Barth J.H.
        • Jackson B.M.
        • Farrin A.J.
        • Efthymiou M.
        • Worthy G.
        • Copeland J.
        • Bailey K.M.
        • Romaine S.P.
        • Balmforth A.J.
        • McCormack T.
        • Whitehead A.
        • Flather M.D.
        • Nixon J.
        • Hall A.S.
        SPACE ROCKET Trial Group. Change in serum lipids after acute coronary syndromes: secondary analysis of SPACE ROCKET study data and a comparative literature review.
        Clin Chem. 2010; 56: 1592-1598