EUR HEART J：HDL-C高水平与血管事件风险降低无关

　　意大利一项研究表明，在接受冠脉旁路移植（CABG）的冠脉疾病患者中，高密度脂蛋白胆固醇（HDL-C）水平较高与血管事件风险降低并无相关性；研究进一步提示应改善HDL—C功能而非升高其水平。论文于5月22日在线发表于《欧洲心脏杂志》（Eur Heart J）。

　　此项研究共纳入1548例接受首次孤立性择期冠脉旁路移植术（CABG）治疗的患者。依据ATPIII标准，利用术前HDL-C值将患者分为高HDL-C组（A组）和低HDL-C组（B组）。利用Kaplan-Meier方法分析累积生存率和主要心血管不良事件（MACE），并利用Cox比例风险回归模型确认MACE和死亡的独立预测因素。

　　结果显示，在中位随访32个月期间，A组和B组各502例患者中分别有44例（8.8%）和36例（7.2%）死亡[危险比（HR） 1.19]。A组和B组的MACE的发生率分别为32.9%（165例）和23.9%（120例）（P=0.04）。回归分析显示，术前HDL-C水平与随访期间MACE发生率降低并无相关性。

Lack of protective role of HDL-C in patients with coronary artery disease undergoing elective coronary artery bypass grafting

Aims 

Primary prevention studies have confirmed that high-density lipoprotein cholesterol (HDL-C) levels are strongly associated with reduced cardiovascular events. However, recent evidence suggests that HDL-C functionality may be impaired under certain conditions. In the present study, we hypothesize that HDL-C may lose their protective role in the secondary prevention of coronary artery disease (CAD).

Methods and results 

A consecutive series of 1548 patients undergoing isolated first-time elective CABG at one institution between 2004 and 2009 was studied. According to the ATPIII criteria, pre-operative HDL-C values were used to identify patients with high (Group A) vs. low HDL-C (Group B). To eliminate biased estimates, a propensity score model was built and two cohorts of 1:1 optimally matched patients were obtained. Cumulative survival and major adverse cardiovascular events (MACE) were analysed by means of Kaplan–Meier method. Cox proportional-hazards regression models were used to identify independent predictors of MACE and death. Propensity matching identified two cohorts of 502 patients each. At a median follow-up time of 32 months, there were 44 out of 502 (8.8%) deaths in Group A and 36 out of 502 deaths in Group B (7.2%, HR 1.19; P = 0.42). MACE occurred in 165 out of 502 (32.9%) in Group A and 120 out of 502 (23.9%) in Group B (P = 0.04). Regression analysis showed that pre-operative HDL-C levels were not associated with reduced but rather increased MACE occurrence during follow-up (HR 1.43, P = 0.11).

Conclusion 

Higher HDL-C levels are not associated with reduced risk of vascular events in CAD patients undergoing CABG. Our findings may support efforts to improve HDL-C functionality instead of increasing their levels.