Background. Patients with coronary artery disease (CAD) are at considerable risk for subsequent cardiovascular events. Although hyperlipidemia accentuates the risk, predictors of subsequent events with CAO and desirable total cholesterol (TC) (<5.2 mmol/l) have not been assessed. Methods and Results. A survival analysis was performed in a subset of 740 consecutive patients who underwent diagnostic coronary arteriography between 1977 and 1978. Eight-three men and 24 women with angiographically documented CAD and desirable TC were followed for subsequent cardiovascular events, including myocardial infarction and cardiovascular death. Over a 13-year period, 75% of CAD subjects with reduced high density lipoprotein cholesterol (HDL-C) (<0.9 mmol/l) developed a subsequent cardiovascular event compared with 45% of those with HDL-C ≥0.9 mmol/l (p=O.002). A Kaplan-Meier analysis revealed significantly greater survival from cardiovascular end points in patients with baseline levels of HDL-C ≥0.9 mmol/l (p=0.005). After 11 variables were tested, an age-adjusted Cox proportional-hazards model identified two pairs of independent predictors of subsequent cardiovascular events: they were a left ventricular ejection fraction (LVEF) <35% (relative risk [RR], 6.5; 95% confidence interval [CI], 2.8,15.3;p<0.001) and reduced HDL-C (RR, 2.0; 95% CI, 1.2,3.3; p=0.01) in the first model and LVEF <35% (RR, 6.5; 95% CI, 2.7,15.6; p<0.001) and TC:HDL ratio ≥5.5 (RR, 1.9; 95% CI, 1.1,3.1; p=0.02) in the second model. Conclusions. Low HDL-C (or high TC:HDL-C) is strongly predictive of subsequent cardiovascular events in subjects with CAD, despite desirable TC. As such, identification of this potentially modifiable risk factor should be actively pursued in this high-risk subgroup.
- Coronary artery disease
- Lipoproteins, high density
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Physiology (medical)