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. 2010 Jul 13;33(7):418–423. doi: 10.1002/clc.20774

A Very High Prevalence of Low HDL Cholesterol in Spanish Patients With Acute Coronary Syndromes

Xavier Pintó 1, Jesús Millán 2, Anna Muñoz 3, Emili Corbella 1, Antonio Hernández‐Mijares 4, Manuel Zuñiga 5, Alipio Mangas 6, Juan Pedro‐Botet 7,✉
PMCID: PMC6653221  PMID: 20641119

Abstract

Background

Total and low‐density lipoprotein cholesterol (LDL‐C) concentrations in coronary artery disease have progressively declined, although high‐density lipoprotein cholesterol (HDL‐C) has not always been evaluated. The prevalence and related factors of low HDL‐C in a cohort of Spanish patients with acute coronary syndromes (ACS) were assessed.

Methods

Clinical and laboratory data registered at admission and at discharge of 648 patients admitted to coronary care units of 6 Spanish hospitals for ACS between January 2004 and September 2007 were analyzed.

Results

Low HDL‐C (HDL‐C < 1.04 mmol/L) was observed in 367 (56.6%) patients. Male gender, smoking, hypertension, diabetes, high body mass index, and triglycerides were related to low HDL‐C. Female gender was the strongest protective factor against low HDL‐C (0.619; 95% confidence interval [CI]: 0.410–0.934; P = 0.022), whereas high triglycerides (1.653; 95% CI: 1.323–2.064; P < 0.001) followed by previous ischemic disease (1.504; 95% CI: 1.073–2.110; P = 0.018) were the strongest factors associated with low HDL‐C. One‐third of patients were taking statins at admission, but only 2% were on fibrate therapy. A large increase in statin therapy, but not in other hypolipemiant drug therapy, between admission and discharge was noted in the whole cohort and among patients with low HDL‐C.

Conclusion

Spanish patients with ACS have a very high prevalence of low HDL‐C. Male gender, high triglycerides, and previous ischemic disease are strong, independent factors associated with this disorder. As low HDL‐C remains almost completely untreated in ACS, strategies to enhance the treatment of this lipoprotein abnormality are urgently required. Copyright © 2010 Wiley Periodicals, Inc.

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References

  • 1. Smith SC Jr, Allen J, Blair SN, et al. AHA/ACC; National Heart, Lung, and Blood Institute. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute. Circulation 2006; 113: 2363–2372. [DOI] [PubMed] [Google Scholar]
  • 2. Graham I, Atar D, Borch‐Johnsen K, et al; ESC Committee for Practice Guidelines. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Atherosclerosis 2007; 194: 1–45. [DOI] [PubMed] [Google Scholar]
  • 3. Grundy SM, Cleeman JI, Merz CN, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004; 110: 227–239. [DOI] [PubMed] [Google Scholar]
  • 4. Hausenloy DJ, Yellon DM. Targeting residual cardiovascular risk: raising high‐density lipoprotein cholesterol levels. Heart 2008; 94: 706–714. [DOI] [PubMed] [Google Scholar]
  • 5. Sachdeva A, Cannon CP, Deedwania PC, et al. 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. [DOI] [PubMed] [Google Scholar]
  • 6.Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 3143–3421. [PubMed] [Google Scholar]
  • 7. Ascaso JF, Fernández‐Cruz A, González Santos P, et al. Significance of high density lipoprotein‐cholesterol in cardiovascular risk prevention: recommendations of the HDL Forum. Am J Cardiovasc Drugs 2004; 4: 299–314. [DOI] [PubMed] [Google Scholar]
  • 8. Castelli WP, Garrison RJ, Wilson PW, Abbott RD, Kalousdian S, Kannel WB. Incidence of coronary heart disease and lipoprotein cholesterol levels. The Framingham Study. JAMA 1986; 256: 2835–2838. [PubMed] [Google Scholar]
  • 9. Sacks FM, Tonkin AM, Craven T, et al. Coronary heart disease in patients with low LDL‐cholesterol: benefit of pravastatin in diabetics and enhanced role for HDL‐cholesterol and triglycerides as risk factors. Circulation 2002; 105: 1424–1428. [DOI] [PubMed] [Google Scholar]
  • 10. Knopp RH, Paramsothy P, Atkinson B, Dowdy A. Comprehensive lipid management versus aggressive low‐density lipoprotein lowering to reduce cardiovascular risk. Am J Cardiol 2008; 101(suppl): 48B–57B. [DOI] [PubMed] [Google Scholar]
  • 11. Gregg EW, Cheng YJ, Cadwell BL, et al. Secular trends in cardiovascular disease risk factors according to body mass index in US adults. JAMA 2005; 293: 1868–1874. [DOI] [PubMed] [Google Scholar]
  • 12. Gordon DJ, Probstfield JL, Garrison RJ, et al. High‐density lipoprotein cholesterol and cardiovascular disease. Four prospective American studies. Circulation 1989; 79: 8–15. [DOI] [PubMed] [Google Scholar]
  • 13. de Oya M. HDL cholesterol and cardiovascular mortality in Spain. Rev Esp Cardiol 1998; 51: 988–990. [DOI] [PubMed] [Google Scholar]
  • 14.The Joint European Society of Cardiology/American College of Cardiology Committee. Myocardial infarction redefined—A consensus document of The Joint European Society of Cardiology/ American College of Cardiology Committee for the Redefinition of Myocardial Infarction. Eur Heart J 2000; 21: 1502–1513. [DOI] [PubMed] [Google Scholar]
  • 15. Thygesen K, Alpert JS, White HD; on behalf of the Joint ESC/ ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction. Eur Heart J 2007; 28: 2525–2538. [DOI] [PubMed] [Google Scholar]
  • 16. Barr DP, Russ EM, Eder HA. Protein‐lipid relationships in human plasma. II. In atherosclerosis and related conditions. Am J Med 1951; 11: 480–493. [DOI] [PubMed] [Google Scholar]
  • 17. Rubins HB, Robins SJ, Collins D, et al. Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high‐density lipoprotein cholesterol. Veterans Affairs High‐Density Lipoprotein Cholesterol Intervention Trial Study Group. N Engl J Med 1999; 341: 410–418. [DOI] [PubMed] [Google Scholar]
  • 18. Goldenberg I, Boyko V, Tennenbaum A, Tanne D, Behar S, Guetta V. Long‐term benefit of high‐density lipoprotein cholesterol‐raising therapy with bezafibrate: 16‐year mortality follow‐up of the bezafibrate infarction prevention trial. Arch Intern Med 2009; 169: 508–514. [DOI] [PubMed] [Google Scholar]
  • 19. Scott R, O'Brien R, Fulcher G, et al; Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) Study Investigators. Effects of fenofibrate treatment on cardiovascular disease risk in 9795 individuals with type 2 diabetes and various components of the metabolic syndrome: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. Diabetes Care 2009; 32: 493–498. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20. Nicholls SJ, Tuzcu EM, Sipahi I, et al. Statins, high‐density lipoprotein cholesterol, and regression of coronary atherosclerosis. JAMA 2007; 297: 499–508. [DOI] [PubMed] [Google Scholar]
  • 21. Genest J Jr, McNamara JR, Ordovas JM, et al. Lipoprotein cholesterol, apolipoprotein A‐I and B and lipoprotein(a) abnormalities in men with premature coronary artery disease. J Am Coll Cardiol 1992; 19: 792–802. [DOI] [PubMed] [Google Scholar]
  • 22. Rubins HB, Robins SJ, Collins D, et al. Distribution of lipids in 8500 men with coronary artery disease. Department of Veterans Affairs HDL Intervention Trial Study Group. Am J Cardiol 1995; 75: 1196–1201. [DOI] [PubMed] [Google Scholar]
  • 23.The Bezafibrate Infarction Prevention (BIP) Study Group. Lipids and lipoproteins in symptomatic coronary heart disease. Distribution, intercorrelations, and significance for risk classification in 6700 men and 1500 women. Circulation 1992; 86: 839–848. [DOI] [PubMed] [Google Scholar]
  • 24. Barter P, Gotto AM, LaRosa JC, et al; Treating to New Targets Investigators. HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events. N Engl J Med 2007; 357: 1301–1310. [DOI] [PubMed] [Google Scholar]
  • 25. de Goma EM, Leeper NJ, Heidenreich PA. Clinical significance of high‐density lipoprotein cholesterol in patients with low low‐density lipoprotein cholesterol. J Am Coll Cardiol 2008; 51: 49–55. [DOI] [PubMed] [Google Scholar]
  • 26. Stampfer MJ, Sacks FM, Salvini S, Willett WC, Hennekens CH. A prospective study of cholesterol, apolipoproteins, and the risk of myocardial infarction. N Engl J Med 1991; 325: 373–381. [DOI] [PubMed] [Google Scholar]
  • 27. Assmann G, Schulte H. Relation of high‐density lipoprotein cholesterol and triglycerides to incidence of atherosclerotic coronary artery disease (the PROCAM experience). Prospective Cardiovascular Münster study. Am J Cardiol 1992; 70: 733–737. [DOI] [PubMed] [Google Scholar]
  • 28. Alsheikh‐Ali AA, Kuvin JT, Karas RH. High‐density lipoprotein cholesterol in the cardiovascular equation: does the “good” still count? Atherosclerosis 2005; 180: 217–223. [DOI] [PubMed] [Google Scholar]
  • 29. Cannon CP, Braunwald E, McCabe CH, et al; for the Pravastatin or Atorvastatin Evaluation and Infection Therapy‐Thrombolysis in Myocardial Infarction 22 Investigators. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004; 350: 1495–1504. [DOI] [PubMed] [Google Scholar]
  • 30. Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005; 365: 1415–1428. [DOI] [PubMed] [Google Scholar]
  • 31. Jeffs JA, Godsland IF, Johnston DG. Less than 50% of variation in HDL cholesterol between and within individuals is explained by established predictors. Atherosclerosis 2006; 184: 178–187. [DOI] [PubMed] [Google Scholar]
  • 32. Ghazzal ZB, Dhawan SS, Sheikh A, et al. Usefulness of serum high‐density lipoprotein cholesterol level as an independent predictor of one‐year mortality after percutaneous coronary interventions. Am J Cardiol 2009; 103: 902–906. [DOI] [PubMed] [Google Scholar]
  • 33. Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, Keil U; EUROASPIRE Study Group. Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries. Lancet 2009; 373: 929–940. [DOI] [PubMed] [Google Scholar]
  • 34. Pfohl M, Schreiber I, Liebich HM, Häring HU, Hoffmeister HM. Upregulation of cholesterol synthesis after acute myocardial infarction—is cholesterol a positive acute phase reactant? Atherosclerosis 1999; 142: 389–393. [DOI] [PubMed] [Google Scholar]
  • 35. Pitt B, Loscalzo J, Ycas J, Raichlen JS. Lipid levels after acute coronary syndromes. J Am Coll Cardiol 2008; 51: 1440–1445. [DOI] [PubMed] [Google Scholar]

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