BMI modifies HDL-C effects on coronary artery bypass grafting outcomes

Abstract

Background Despite the recognized implications of high-density lipoprotein cholesterol (HDL-C) in cardiovascular diseases, the role of body mass index (BMI) in HDL-C association with cardiovascular outcomes remains unclear. This study investigated the possible modifying implications of BMI on the correlation between HDL-C and coronary artery bypass grafting (CABG) outcomes. Methods The present cohort included isolated CABG patients (median follow-up: 76.58 [75.79–77.38] months). The participants were classified into three groups: 18.5 ≤ BMI < 25 (normal), 25 ≤ BMI < 30 (overweight), and 30 ≤ BMI < 35 (obese) kg/m2. Cox proportional hazard models (CPHs) and restricted cubic splines (RCSs) were applied to evaluate the relationship between HDL-C and all-cause mortality as well as major adverse cardio-cerebrovascular events (MACCEs) in different BMI categories. Results This study enrolled a total of 15,639 patients. Considering the final Cox analysis among the normal and overweight groups, HDL-C ≥ 60 was a significant protective factor compared to 40 < HDL-C < 60 for all-cause mortality (adjusted hazard ratio (aHR): 0.47, P: 0.027; and aHR: 0.64, P: 0.007, respectively). However, the protective effect of HDL-C ≥ 60 was no longer observed among patients with 30 ≤ BMI < 35 (aHR: 1.16, P = 0.668). RCS trend analyses recapitulated these findings; among 30 ≤ BMI < 35, no uniform inverse linear association was observed; after approximately HDL-C≈55, its increase was no longer associated with reduced mortality risk. RCS analyses on MACCE revealed a plateau effect followed by a modest rise in overweight and obese patients from HDL-C = 40 onward (nonlinear association). Conclusions Very high HDL-C (≥ 60 mg/dL) was not related to better outcomes among obese CABG patients. Furthermore, HDL-C was related to the post-CABG outcomes in a nonlinear manner, and the magnitude of its effects also differed across BMI subgroups.

The prognostic role of the low and very low baseline LDL-C level in outcomes of patients with cardiac revascularization; comparative registry-based cohort design

“…A second explanation may be that patients with higher cholesterol concentrations are more likely to be taking medications such as β-blockers and angiotensin-converting enzyme inhibitors before their admission; as a result, these medications may individually or synergistically contribute to the paradoxically lower risk of patients with 70 mg/dl < LDL-C ≤ 100 mg/dl as compared to patients with LDL-C < 70 mg/dl. A third explanation may be that in patients with very low serum LDL-C levels, HDL-C levels are also comparatively lower, which may be prognostically more impactful than the former [ 32 ]. Accordingly, Ogita et al revealed that, despite achieving optimal LDL-C control after coronary revascularization, diabetic patients with low serum HDL-C levels had higher rates of major cardiovascular events [ 33 ].…”

Evaluating the pure effect of weight on cardiac function in patients with cardiac syndrome X

“…Obesity is a complex, multifactorial, and largely preventable disease, affecting up to a third of the world's population in the recent decades. [1][2][3] Obesity is a major risk factor for cardiovascular complications and heart failure by predisposing to hypertension, dyslipidemia, diabetes mellitus, coronary artery disease, and sleep apnea syndrome. [4][5][6][7][8][9][10] Several mechanisms are involved in the pathogenesis of left ventricle (LV) dysfunction in obese individuals.…”

Novel Anthropometric Indices as Screening Tools for Obesity: A Study on Healthy Iranians

“…Recent studies suggested that BMI-which only depends on height and weight-cannot indicate body fat content accurately [6]. Anthropometric indices that evaluate central adiposity such as waist circumference (WC) and waist-to-height ratio (WHtR) have been suggested to correlate with cardiometabolic disorders more than BMI [7][8][9][10]. WC is associated with cardiovascular diseases and metabolic syndrome.…”