Prediction value of LDL/HDL-cholesterol ratio for long-term prognosis after acute coronary syndrome and correlation with coronary artery disease severity

    Authors

    Keywords

    dyslipidaemia, low-density lipoprotein cholesterol, acute coronary syndrome

    DOI

    https://doi.org/10.15836/ccar2024.372

    Full Text

    **Introduction**: Dyslipidaemia is an important correctable risk factor for coronary artery disease (CAD). Studies have shown that low levels of low-density lipoprotein cholesterol (LDL-C) correlate with lower CAD morbidity and mortality rates (1). Many patients who achieved low levels of LDL-C still encounter a major adverse cardiovascular event (MACE) due to other risk factors. Better stratification of patients at higher risk for novel MACE after first acute coronary syndrome (ACS) is needed. Evidence indicate that LDL-C/HDL-C ratio could be a better predictor of cardiovascular disease, as it includes levels of both LDL-C and HDL-C (2, 3). The aim of this study was to investigate the prediction value of LDL-C/HDL-C ratio for long term prognosis after ACS and correlation with CAD severity. **Patients and Methods**: We included patients hospitalized at our centre with ACS from January 2017 to 2024. Demographic data, data on LDL-C and HDL-C levels on admission and calculated Syntax score were used. Syntax score is an angiographic scoring system which determines complexity by using coronary anatomy and lesion characteristic (3). Follow-up data were collected by clinical visits or telephone interviews. MACE was defined as the composite of cardiovascular death, ACS and need for surgical or percutaneous revascularization. **Results**: This registry-based study included 2471 patients with ACS, median age of 64 (IQR 56-73) years, 69% male. Median follow up was 17 (3-27) months. 44% had non-ST elevation (NSTE) ACS and 54% had ST elevation myocardial infarction (STEMI). Median Syntax score was 13 (IQR 7-20.5), with 61% patients having low (≤16), 21% patients medium (16-22), and 18% high Syntax score (>22), respectively. LDL-C/HDL-C ratio correlated significantly with cardiovascular death, with weak coefficient (2.94 vs. 2.54 p<0.001; rho=0.102, p<.0001), but did not correlate with MACE (2.88 vs. 2.92, p=0.188, rho=0.06, p=0.77) or CAD severity as assessed by Syntax score (low 2.92 vs. medium 2.83 vs. high 2.86, p=0.597; rho=0.4, p=0.09). This remained the same in both STEMI and NSTE ACS patients. **Conclusion**: Our data suggest that LDL-C/HDL-C ratio can not be used as a relevant predictor of long-term MACE after ACS, cardiovascular death or CAD severity. Additional studies are needed to establish the real value of LDL-C/HDL-C ratio.

    Literature

    1. Dembowski E, Freedman I, Grundy SM, Stone NJ. Guidelines for the management of hyperlipidemia: How can clinicians effectively implement them? Prog Cardiovasc Dis. 2022 November-December;75:4–11. https://doi.org/10.1016/j.pcad.2022.11.009
    2. Lin T, Wang L, Guo J, Liu P, Chen L, Wei M, et al. Association Between Serum LDL-C and ApoB and SYNTAX Score in Patients With Stable Coronary Artery Disease. Angiology. 2018 September;69(8):724–9. https://doi.org/10.1177/0003319717748771
    3. Sinning C, Lillpopp L, Appelbaum S, Ojeda F, Zeller T, Schnabel R, et al. Angiographic score assessment improves cardiovascular risk prediction: the clinical value of SYNTAX and Gensini application. Clin Res Cardiol. 2013 July;102(7):495–503. https://doi.org/10.1007/s00392-013-0555-4
    Cardiologia Croatica
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    Prediction value of LDL/HDL-cholesterol ratio for long-term prognosis after acute coronary syndrome and correlation with coronary artery disease severity

    Extended Abstract
    Issue11-12
    Published
    Pages372
    PDF via DOIhttps://doi.org/10.15836/ccar2024.372
    dyslipidaemia
    low-density lipoprotein cholesterol
    acute coronary syndrome

    Authors

    Martina God*ORCIDDubrava University Hospital Zagreb, Croatia
    Šime ManolaORCIDDubrava University Hospital Zagreb, Croatia
    Andrej NovakORCIDUniversity of Zagreb, Faculty of Science, Zagreb, Croatia
    Irzal HadžibegovićORCIDDubrava University Hospital Zagreb, Croatia
    Nikola PavlovićORCIDDubrava University Hospital Zagreb, Croatia
    Tomislav ŠipićORCIDDubrava University Hospital Zagreb, Croatia
    Marin PavlovORCIDDubrava University Hospital Zagreb, Croatia
    Aleksandar BlivajsORCIDDubrava University Hospital Zagreb, Croatia
    Mario UdovičićORCIDDubrava University Hospital Zagreb, Croatia
    Ante LisičićORCIDDubrava University Hospital Zagreb, Croatia
    Ama ŠermanORCIDUniversity of Zagreb, Zagreb, Croatia
    Ivan ZeljkovićORCIDDubrava University Hospital Zagreb, Croatia
    Ivana JurinORCIDDubrava University Hospital Zagreb, Croatia

    *Correspondence email: martina.god@gmail.com

    Full Text

    Introduction: Dyslipidaemia is an important correctable risk factor for coronary artery disease (CAD). Studies have shown that low levels of low-density lipoprotein cholesterol (LDL-C) correlate with lower CAD morbidity and mortality rates (1). Many patients who achieved low levels of LDL-C still encounter a major adverse cardiovascular event (MACE) due to other risk factors. Better stratification of patients at higher risk for novel MACE after first acute coronary syndrome (ACS) is needed. Evidence indicate that LDL-C/HDL-C ratio could be a better predictor of cardiovascular disease, as it includes levels of both LDL-C and HDL-C (2, 3). The aim of this study was to investigate the prediction value of LDL-C/HDL-C ratio for long term prognosis after ACS and correlation with CAD severity.

    Patients and Methods: We included patients hospitalized at our centre with ACS from January 2017 to 2024. Demographic data, data on LDL-C and HDL-C levels on admission and calculated Syntax score were used. Syntax score is an angiographic scoring system which determines complexity by using coronary anatomy and lesion characteristic (3). Follow-up data were collected by clinical visits or telephone interviews. MACE was defined as the composite of cardiovascular death, ACS and need for surgical or percutaneous revascularization.

    Results: This registry-based study included 2471 patients with ACS, median age of 64 (IQR 56-73) years, 69% male. Median follow up was 17 (3–27) months. 44% had non-ST elevation (NSTE) ACS and 54% had ST elevation myocardial infarction (STEMI). Median Syntax score was 13 (IQR 7-20.5), with 61% patients having low (≤16), 21% patients medium (16–22), and 18% high Syntax score (>22), respectively. LDL-C/HDL-C ratio correlated significantly with cardiovascular death, with weak coefficient (2.94 vs. 2.54 p<0.001; rho=0.102, p<.0001), but did not correlate with MACE (2.88 vs. 2.92, p=0.188, rho=0.06, p=0.77) or CAD severity as assessed by Syntax score (low 2.92 vs. medium 2.83 vs. high 2.86, p=0.597; rho=0.4, p=0.09). This remained the same in both STEMI and NSTE ACS patients.

    Conclusion: Our data suggest that LDL-C/HDL-C ratio can not be used as a relevant predictor of long-term MACE after ACS, cardiovascular death or CAD severity. Additional studies are needed to establish the real value of LDL-C/HDL-C ratio.

    Literature

    1. 1.
      Dembowski E, Freedman I, Grundy SM, Stone NJ. Guidelines for the management of hyperlipidemia: How can clinicians effectively implement them? Prog Cardiovasc Dis. 2022 November-December;75:4–11.DOI
    2. 2.
      Lin T, Wang L, Guo J, Liu P, Chen L, Wei M, et al. Association Between Serum LDL-C and ApoB and SYNTAX Score in Patients With Stable Coronary Artery Disease. Angiology. 2018 September;69(8):724–9.DOI
    3. 3.
      Sinning C, Lillpopp L, Appelbaum S, Ojeda F, Zeller T, Schnabel R, et al. Angiographic score assessment improves cardiovascular risk prediction: the clinical value of SYNTAX and Gensini application. Clin Res Cardiol. 2013 July;102(7):495–503.DOI