Association Between High Density Lipoprotein Cholesterol Level And Prognosis Of Patients With Coronary Heart Disease Undergoing Percutaneous Coronary Intervention

Objective: To explore the impact of high density lipoprotein cholesterol(HDL-C)levels on the prognosis of patients with coronary heart disease(CHD)undergoing percutaneous coronary intervention(PCI)in real-world clinical practice,and to further observe and analyze the effects of gender,body mass index(BMI)and diabetes mellitus(DM)on the correlation between HDL-C and prognosis.Methods: The OPT-CAD(Optimal anti Platelet Therapy for Chinese patients with Coronary Artery Disease,clinicaltrials.gov: NCT01735305)was a large registration study,with a total of 14032 CHD patients enrolled.In this study,7747 patients with CHD undergoing PCI who completed 5-year follow-up in the OPT-CAD study were included and divided into quartile groups according to HDL-C levels to investigate the effect of HDL-C on the prognosis of patients.Then,stratified analysis was conducted according to gender,BMI and DM to further observe and analyze the difference in the correlation between HDL-C and prognosis.The primary outcomes of concern in this study were ischemic events at 5 years,including cardiogenic death,myocardial infarction(MI),and/or ischemic stroke.Secondary outcomes included independent components of ischemic events,all-cause death and bleeding events as defined by the Bleeding Academic Research Consortium(BARC),including BARC 2-5 and BARC 3-5 bleeding.To observe the association between HDL-C levels and outcomes,the restricted cubic splines(RCS)were used to test the nonlinear relationship between them.Results: This study selected 7747 CHD patients undergoing PCI,which was divided into Q1: HDL-C<0.83mmol/L(N=1912),Q2:0.83mmol/L to 0.99mmol/L(N=1866),Q3:1.00mmol/L to 1.21mmol/L(N=2013)and Q4: ≥1.22mmol/L(N=1956).Age,the female ratio increased with the raising of HDL-C levels,BMI,combined DM,hypertension,hyperlipidemia,smoking,previous MI,and previous PCI proportion decreased(P < 0.05).Among the type of CHD,unstable angina(UA)was the most common type in patients,with ST-segment elevation myocardial infarction(STEMI)predominating in the Q4 group and UA in the Q1 group(P < 0.05).The level of estimated glomerular filtration rate(e GFR),left ventricular ejection fraction(LVEF),and anemia rate reduced(P < 0.05).At the same time,Patients had lower triglyceride(TG)levels,higher total cholesterol(TC),and low density lipoprotein cholesterol(LDL-C)(P < 0.05).In terms of interventional treatment,compared with lower HDL-C,patients with higher HDL-C levels had a higher proportion of left anterior descending branch lesions,and a larger mean stent diameter,while the proportion of left circumflex branch lesions,right coronary artery lesions,chronic complete occlusion lesions,the number,and the total length of stents was lower(P < 0.05).As HDL-C levels increased,the proportion of β-blockers,Angiotensin converting enzyme inhibitor(ACEI),or Angiotensin receptor blocker(ARB)used decreased and proton pump inhibitors(PPI)increased.The incidence of all bleeding at 5 years was significantly decreased with the increase of HDL-C levels(P=0.0013).RCS was used to test the nonlinear relationship between HDL-C levels and the risk of endpoints.The ischemic events were associated with HDL-C in U-shaped(P nonlinear=0.032).Further stratified analysis showed that a U-shaped association was found between ischemic events,all-cause death,and HDL-C in men(P nonlinear=0.007),but no nonlinearity was observed in women.In patients with BMI < 25kg/m2,the risk of all-cause death was U-shaped in relation to HDL-C levels(P nonlinearity=0.005),but no nonlinearity was found in patients with BMI≥25kg/m2.There was a nonlinear relationship between ischemic events and HDL-C levels in DM patients,which was a U-shaped curve(P nonlinear=0.02),but the correlation was not valid in non-DM patients.Conclusion: In this study,we found a U-shaped correlation between continuous HDL-C levels and 5-year ischemic events in CHD patients undergoing PCI.The further stratified analysis revealed a U-shaped curve between ischemic events and HDL-C in male patients,but not in female patient.Patients with BMI < 25kg/m2 showed a U-shaped association between all-cause death and HDL-C,but no such association was found in patients with BMI≥25kg/m2.The nonlinear association between ischemic events and HDL-C levels in DM patients was established as a U-shaped curve,but this correlation was not demonstrated in non-DM patients.And HDL-C levels were associated with a reduced risk of all bleeding in patients.