title: Lack of protective role of HDL-C in patients with coronary artery disease undergoing elective coronary artery bypass grafting.
abstract: OBJECTIVE
  Primary prevention studies have confirmed that high-density lipoprotein cholesterol (HDL-C) levels are strongly associated with reduced cardiovascular events. However, recent evidence suggests that HDL-C functionality may be impaired under certain conditions. In the present study, we hypothesize that HDL-C may lose their protective role in the secondary prevention of coronary artery disease (CAD).
  
  
  RESULTS
  A consecutive series of 1548 patients undergoing isolated first-time elective CABG at one institution between 2004 and 2009 was studied. According to the ATPIII criteria, pre-operative HDL-C values were used to identify patients with high (Group A) vs. low HDL-C (Group B). To eliminate biased estimates, a propensity score model was built and two cohorts of 1:1 optimally matched patients were obtained. Cumulative survival and major adverse cardiovascular events (MACE) were analysed by means of Kaplan-Meier method. Cox proportional-hazards regression models were used to identify independent predictors of MACE and death. Propensity matching identified two cohorts of 502 patients each. At a median follow-up time of 32 months, there were 44 out of 502 (8.8%) deaths in Group A and 36 out of 502 deaths in Group B (7.2%, HR 1.19; P = 0.42). MACE occurred in 165 out of 502 (32.9%) in Group A and 120 out of 502 (23.9%) in Group B (P = 0.04). Regression analysis showed that pre-operative HDL-C levels were not associated with reduced but rather increased MACE occurrence during follow-up (HR 1.43, P = 0.11).
  
  
  CONCLUSIONS
  Higher HDL-C levels are not associated with reduced risk of vascular events in CAD patients undergoing CABG. Our findings may support efforts to improve HDL-C functionality instead of increasing their levels.
authors.affiliation: Department of Cardiac Surgery, University of Rome 'Sapienza', Ospedale Sant'Andrea, Rome, Italy.
authors.forename: Emiliano
authors.initials: E
authors.lastname: Angeloni
authors.forename: Francesco
authors.initials: F
authors.lastname: Paneni
authors.forename: Ulf
authors.initials: U
authors.lastname: Landmesser
authors.forename: Umberto
authors.initials: U
authors.lastname: Benedetto
authors.forename: Giovanni
authors.initials: G
authors.lastname: Melina
authors.forename: Thomas Felix
authors.initials: TF
authors.lastname: Lüscher
authors.forename: Massimo
authors.initials: M
authors.lastname: Volpe
authors.forename: Riccardo
authors.initials: R
authors.lastname: Sinatra
authors.forename: Francesco
authors.initials: F
authors.lastname: Cosentino
mesh_terms: D000368:Aged; D008076:Cholesterol, HDL / Q000378:metabolism / Q000502:physiology*; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000401:mortality; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D055502:Secondary Prevention
chemical_list: D008076:Cholesterol, HDL
keywords: Cardiovascular mortality; Coronary artery bypass grafting; Dysfunctional HDL-C; Secondary prevention