Relationship Between Serum Low-Density Lipoprotein Cholesterol and In-hospital Mortality Following Acute Myocardial Infarction (The Lipid Paradox)

Reddy, Vanessa S; Bui, Quang T.; Jacobs, Joan R.; Begelman, Susan M.; Miller, Dave P.; French, William J.

doi:10.1016/j.amjcard.2014.12.006

Cited by 104 publications

(100 citation statements)

References 21 publications

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“…47 Some studies have even shown inverse associations of LDL-C after MI with all-cause mortality. 23–25 Our study further adds to the literature by using directly measured LDL-C, non-HDL-C and LDL pattern B. We found that the event rate was higher in patients with LDL-C <100 mg/dL than the overall population, which further substantiates our findings.…”

Section: Discussionsupporting

confidence: 85%

“…This is because both LDL cholesterol 23–25 and triglycerides rich remnant cholesterol levels 39 were previously shown to have an inverse relationship with mortality after MI. Such analyses can help understand whether the association of LDL pattern was independent of LDL-C and triglycerides.…”

Section: Resultsmentioning

confidence: 98%

“…17 Similarly, most studies have shown greater mortality risk associated with higher serum cholesterol levels in patients with coronary heart disease (CHD), 18–22 although a few studies have shown an inverse association of LDL-C with mortality after myocardial infarction (MI). 23–25 We hypothesized that among patients recovering from MI, presence of LDL pattern B (small, dense LDL particles) would be associated with an increased risk of death as compared with LDL pattern A (large, buoyant LDL particles). We further hypothesized that such relationship would be present even in patients with relatively controlled LDL-C levels (i.e., <100 mg/dL).…”

Section: Introductionmentioning

confidence: 99%

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Association of low-density lipoprotein pattern with mortality after myocardial infarction: Insights from the TRIUMPH study

Pokharel

Tang

Bhardwaj

et al. 2017

Journal of Clinical Lipidology

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Background Studies of incident coronary heart disease risk within low-density lipoprotein (LDL) subclass (small, dense vs. large, buoyant) have shown mixed results. No prospective cohort study has examined the association of small, dense or large, buoyant LDL with mortality after myocardial infarction (MI). Objective To examine association of LDL pattern after MI and death Methods In 2476 patients hospitalized for MI, LDL pattern [A (large, buoyant), A/B (mixed) and B (small, dense)] was established by ultracentrifugation using Vertical Auto Profile. Using time-to-event analysis, we examined the association with 5-year mortality within LDL patterns, after adjusting for important patient and treatment characteristics. We additionally adjusted for LDL cholesterol (LDL-C) and triglyceride levels and used directly measured LDL-C and non-HDL-C as exposures. Results Patterns A, A/B and B were present in 39%, 28% and 33% of patients, respectively, with incident rates (per 1000 patient-years) of 50, 34 and 24 for all-cause and 24, 19 and 10 for CV mortality. The HRs (95% CI) with LDL patterns A/B and B compared to pattern A were 0.77 (0.61, 0.99) and 0.67 (0.51, 0.88) for all-cause, 0.94 (0.67, 1.33) and 0.69 (0.46, 1.03) for cardiovascular, and 0.64 (0.45, 0.91) and 0.65 (0.45, 0.93) for non-cardiovascular mortality, respectively. Results were similar when further adjusted for LDL-C and triglycerides, or with LDL-C and non-HDL-C as exposures. Conclusion Compared with LDL pattern A, pattern B was significantly associated with reduced all-cause and non-CV mortality with a trend for lower CV mortality after MI, independent of LDL-C and triglycerides.

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Section: Discussionsupporting

confidence: 85%

Section: Resultsmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Association of low-density lipoprotein pattern with mortality after myocardial infarction: Insights from the TRIUMPH study

Pokharel

Tang

Bhardwaj

et al. 2017

Journal of Clinical Lipidology

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“…Among 32 826 postmenopausal women from the Nurses' Health Study, high-density lipoprotein cholesterol was the lipid parameter that best discriminated risk of CHD. 163 Lipoproteins levels are associated with long-term cardiovascular risk; however, in the AMI setting, there is a lipid paradox: Patients with significantly lower triglycerides and low-density lipoprotein cholesterol levels have higher in-hospital 164 and 30-day mortality rates. 165 This seeming paradox may be due to competing risks of collider (index event) bias resulting from the selection of a diseased population 166 such as older age and higher rates of DM in those with lower lipoprotein levels in the acute setting.…”

Section: Hypertensionmentioning

confidence: 99%

Acute Myocardial Infarction in Women

Mehta¹,

Beckie²,

DeVon³

et al. 2016

Circulation

910

393

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Cardiovascular disease is the leading cause of mortality in American women. Since 1984, the annual cardiovascular disease mortality rate has remained greater for women than men; however, over the last decade, there have been marked reductions in cardiovascular disease mortality in women. The dramatic decline in mortality rates for women is attributed partly to an increase in awareness, a greater focus on women and cardiovascular disease risk, and the increased application of evidence-based treatments for established coronary heart disease. This is the first scientific statement from the American Heart Association on acute myocardial infarction in women. Sex-specific differences exist in the presentation, pathophysiological mechanisms, and outcomes in patients with acute myocardial infarction. This statement provides a comprehensive review of the current evidence of the clinical presentation, pathophysiology, treatment, and outcomes of women with acute myocardial infarction.

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“…Reddy et al [18], in a retrospective study that included over 100 000 patients hospitalized for acute MI, found that, despite the chronic nature of the cases, patients with lower levels of LDL cholesterol who were hospitalized after an acute coronary syndrome had a higher rate of inhospital mortality. This finding suggests a lipid paradox, which might be associated with reduced lipoprotein synthesis and secretion because of inflammation in the liver and hepatic dysfunction after acute MI.…”

Section: Discussionmentioning

confidence: 98%

The value of the Clinical SYNTAX Score in predicting long-term prognosis in patients with ST-segment elevation myocardial infarction who have undergone primary percutaneous coronary intervention

Çetinkal

Dogan²,

Kocas³

et al. 2016

Coronary Artery Disease

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Relationship Between Serum Low-Density Lipoprotein Cholesterol and In-hospital Mortality Following Acute Myocardial Infarction (The Lipid Paradox)

Cited by 104 publications

References 21 publications

Association of low-density lipoprotein pattern with mortality after myocardial infarction: Insights from the TRIUMPH study

Association of low-density lipoprotein pattern with mortality after myocardial infarction: Insights from the TRIUMPH study

Acute Myocardial Infarction in Women

The value of the Clinical SYNTAX Score in predicting long-term prognosis in patients with ST-segment elevation myocardial infarction who have undergone primary percutaneous coronary intervention

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