High-density lipoprotein cholesterol level and pulmonary artery vasoreactivity in patients with idiopathic pulmonary arterial hypertension

Abstract

Introduction Metabolic dysregulation has been recognized as a prognostic marker in idiopathic pulmonary arterial hypertension (IPAH). Objectives We aimed to investigate the association between cardiometabolic risk factors and vascular reactivity of pulmonary arteries in patients with IPAH. Patients and methods Between June 2009 and January 2015, we recruited 66 consecutive patients with IPAH. We assessed main cardiometabolic risk factors, inflammatory markers, and markers of IPAH severity. Hemodynamic evaluation included pulmonary vasoreactivity testing with the use of inhaled nitric oxide. Reduced mean pulmonary artery pressure was considered a marker of acute vasoreactivity. Acute responders were treated with calcium channel blockers and classified as long‑term responders if they had sustained vasoreactivity (near‑normal hemodynamics and World Health Organization functional class I or II) for at least 1 year. Results Thirteen patients (19.7%) showed a positive response to acute pulmonary vasoreactivity testing; however, only 9 (13.6%) remained vasoreactive at follow‑up. Machine‑learning algorithms indicated 4 variables associated with acute vasoreactivity of pulmonary arteries: high‑density lipoprotein cholesterol (HDL‑C), right atrial pressure, cardiac index, and creatinine level, and 4 predictors of long‑term vasoreactivity: HDL‑C, 6‑minute walking distance, creatinine level, and high‑sensitive C‑reactive protein level. Conclusions HDL‑C level is associated with pulmonary vasoreactivity in acute testing and predicts long‑term responsiveness to calcium channel blockers in patients with IPAH.

Prognostic role of traditional cardiovascular risk factors in patients with idiopathic pulmonary arterial hypertension

“…Numerous studies have confirmed that inflammatory cytokines can both increase TG and decrease HDL-C levels and in consequence elevate the TG/HDL-C ratio [36]. We have also shown that interleukin 1β, interleukin 6 and high-sensitivity C-reactive protein correlate with the level of HDL-C [37]. What is more, TG/HDL-C was recently proposed as a novel risk factor in PAH patients [6].…”

HDL Cholesterol as a Marker of Disease Severity and Prognosis in Patients with Pulmonary Arterial Hypertension

“…In our recent study of 66 idiopathic PAH patients, we showed that HDL was able to predict pulmonary artery vasoreactivity and long-term response to calcium channel blocker therapy in patients with newly diagnosed disease. Additionally, we demonstrated that lower levels of HDL-C are correlated with inflammatory cytokines; this indicates that chronic inflammation can mediate the relationship between HDL-C and function of pulmonary vasculature [59,85]. The vasoprotective role of HDL was also recently described in 90 patients with chronic thromboembolic pulmonary hypertension (CTEPH).…”

Decreased low‑density lipoprotein and the presence of pulmonary arterial hypertension among newly diagnosed drug‑naïve patients with systemic lupus erythematosus: D‑dimer as a mediator

“…In patients with PH, the levels of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) are decreased (11)(12)(13). Thus, HDL and LDL have been suggested as markers for prediction and assessment of PH (11,14). In addition, a study suggested that inflammation triggered by CTDs can lead to dysregulation of lipid metabolism (15).…”