HDL cholesterol level predicts survival in men after coronary artery bypass graft surgery: 20-year experience from The Cleveland Clinic Foundation.
BACKGROUND
HDL cholesterol (HDL-C) is an important independent predictor of atherosclerosis, yet the role that HDL-C may play in the prediction of long-term survival after CABG remains unclear. The risk associated with a low HDL-C level in post-CABG men has not been delineated in relation to traditional surgical variables such as the use of arterial conduits, left ventricular function, and extent of disease.


RESULTS
We performed a prospective, observational study of 432 men who underwent CABG between 1978 and 1979 in whom preoperative HDL-C values were available. Baseline lipid and lipoprotein values, history of diabetes mellitus and hypertension, left ventricular ejection fraction, extent of disease, and use of internal thoracic arteries were recorded. Hazard ratios (HRs) were determined in the patients with and without a low HDL-C level, which was defined as the lowest HDL-C quartile (HDL-C </=35 mg/dL). After adjustment for age, as well as for baseline metabolic parameters and surgical variables just noted, HDL-C corresponded to both overall (HR 0.40, CI 0.20 to 0.83, P:=0.01) and event-free (HR 0.41, CI 0.24 to 0.70, P:=0.001) survival. Patients with a high HDL-C level (>35 mg/dL) were 50% more likely to survive at 15 years than were patients with low HDL-C level (</=35 mg/dL) (74% versus 57% adjusted survival, respectively; HR 1.72, P:=0.005). In addition, HDL-C showed a strong effect on time-to-event survival such that patients with an HDL-C level of >35 mg/dL were 50% more likely to survive without a subsequent myocardial infarction or revascularization (HR 1.42, P:=0.02).


CONCLUSIONS
HDL-C is an important predictor of survival in post-CABG patients. In this study of >8500 patient-years of follow-up, HDL-C was the most important metabolic predictor of post-CABG survival. One third fewer patients survive at 15 years if their HDL-C levels are </=35 mg/dL at the time of CABG. The measurement of HDL-C provides a compelling strategy for the identification of high-risk subsets of patients who undergo CABG.
Foody
J M
JM
Section of Preventive Cardiology, Departments of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Ferdinand
F D
FD
Pearce
G L
GL
Lytle
B W
BW
Cosgrove
D M
DM
Sprecher
D L
DL
D008076:Cholesterol, HDL / Q000097:blood*; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000097:blood* / Q000401:mortality* / Q000601:surgery; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D015996:Survival Rate / Q000639:trends
D008076:Cholesterol, HDL