Lower LDL-cholesterol levels associated with increased inflammatory burden in patients with acute ST-segment elevation myocardial infarction

Açıkgöz, Eser; Açi̇kgöz, Sadık Kadri; Yaman, Belma; Kurtul, Alparslan

doi:10.1590/1806-9282.67.02.20200548

Cited by 5 publications

(1 citation statement)

References 28 publications

(38 reference statements)

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“…At first glance, it is surprising that a low HDL cholesterol concentration correlates with a better perioperative outcome. Yet, it has long been known that all lipid fractions are considered negative acute phase reactants [24,25]. This implies that their concentration decreases in acute or chronic stress.…”

Section: Discussionmentioning

confidence: 99%

Effect of Perioperative Lipid Status on Clinical Outcomes after Cardiac Surgery

Mihalj

Heinisch

Huber

et al. 2021

Cells

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Patients undergoing cardiac surgery are at increased cardiovascular risk, which includes altered lipid status. However, data on the effect of cardiac surgery and cardiopulmonary bypass (CPB) on plasma levels of key lipids are scarce. We investigated potential effects of CPB on plasma lipid levels and associations with early postoperative clinical outcomes. This is a prospective bio-bank study of patients undergoing elective cardiac surgery at our center January to December 2019. The follow-up period was 1 year after surgery. Blood sampling was performed before induction of general anesthesia, upon weaning from cardiopulmonary bypass (CPB), and on the first day after surgery. Clinical end points included the incidence of postoperative stroke, myocardial infarction, and death of any cause at 30 days after surgery as well as 1-year all-cause mortality. A total of 192 cardiac surgery patients (75% male, median age 67.0 years (interquartile range 60.0–73.0), median BMI 26.1 kg/m2 (23.7–30.4)) were included. A significant intraoperative decrease in plasma levels compared with preoperative levels (all p < 0.0001) was observed for total cholesterol (TC) (Cliff’s delta d: 0.75 (0.68–0.82; 95% CI)), LDL-Cholesterol (LDL-C) (d: 0.66 (0.57–0.73)) and HDL-Cholesterol (HDL-C) (d: 0.72 (0.64–0.79)). At 24h after surgery, the plasma levels of LDL-C (d: 0.73 (0.650.79)) and TC (d: 0.77 (0.69–0.82)) continued to decrease compared to preoperative levels, while the plasma levels of HDL-C (d: 0.46 (0.36–0.55)) and TG (d: 0.40 (0.29–0.50)) rebounded, but all remained below the preoperative levels (p < 0.001). Mortality at 30 days was 1.0% (N = 2/192), and 1-year mortality was 3.8% (N= 7/186). Postoperative myocardial infarction occurred in 3.1% of patients (N = 6/192) and postoperative stroke in 5.8% (N = 11/190). Adjusting for age, sex, BMI, and statin therapy, we noted a protective effect of postoperative occurrence of stroke for pre-to-post-operative changes in TC (adjusted odds ratio (OR) 0.29 (0.07–0.90), p = 0.047), in LDL-C (aOR 0.19 (0.03–0.88), p = 0.045), and in HDL-C (aOR 0.01 (0.00–0.78), p = 0.039). No associations were observed between lipid levels and 1-year mortality. In conclusion, cardiac surgery induces a significant sudden drop in levels of key plasma lipids. This effect was pronounced during the operation, and levels remained significantly lowered at 24 h after surgery. The intraoperative drops in LDL-C, TC, and HDL-C were associated with a protective effect against occurrence of postoperative stroke in adjusted models. We demonstrate that the changes in key plasma lipid levels during surgery are strongly correlated, which makes attributing the impact of each lipid to the clinical end points, such as postoperative stroke, a challenging task. Large-scale analyses should investigate additional clinical outcome measures.

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Section: Discussionmentioning

confidence: 99%

Effect of Perioperative Lipid Status on Clinical Outcomes after Cardiac Surgery

Mihalj

Heinisch

Huber

et al. 2021

Cells

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Phenotypic changes in low-density lipoprotein particles as markers of adverse clinical outcomes in COVID-19

Carmo

Yoshinaga

Castillo

et al. 2023

Molecular Genetics and Metabolism

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Probiotics Bring New Hope for Atherosclerosis Prevention and Treatment

Zhai

Wang

et al. 2022

Oxidative Medicine and Cellular Longevity

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Cardiovascular disease is the leading cause of human mortality and morbidity worldwide. Atherosclerosis (AS) is the underlying pathological responsible in most acute and severe cardiovascular diseases including myocardial infarction and stroke. However, current drugs applied to the treatment of AS are not clinically effective, and there is a large residual risk of cardiovascular disease and multiple side effects. Increasing evidence supports a close relationship between microorganisms and the incidence of AS. Recent data have shown that probiotics can improve multiple key factors involved in the development and progression of AS, including cholesterol metabolism imbalance, endothelial dysfunction, proinflammatory factor production, macrophage polarization, intestinal flora disturbance, and infection with pathogenic microorganisms, and therefore probiotics have attracted great interest as a novel potential “medicine”. This review is aimed at summarizing the effects of probiotics on various influencing factors, and providing valuable insights in the search for early prevention and potential therapeutic strategies for AS.

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Lower LDL-cholesterol levels associated with increased inflammatory burden in patients with acute ST-segment elevation myocardial infarction

Cited by 5 publications

References 28 publications

Effect of Perioperative Lipid Status on Clinical Outcomes after Cardiac Surgery

Effect of Perioperative Lipid Status on Clinical Outcomes after Cardiac Surgery

Phenotypic changes in low-density lipoprotein particles as markers of adverse clinical outcomes in COVID-19

Probiotics Bring New Hope for Atherosclerosis Prevention and Treatment

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