title: Predictive value of HDL cholesterol for cancer-associated venous thromboembolism during chemotherapy.
abstract: BACKGROUND
  Dyslipidemia is a well-known risk factor for the development of atherothrombosis; however, its involvement in venous thromboembolism (VTE) is still debated. Low levels of HDL cholesterol (HDL-C) have been found to be associated with VTE, which is a common complication of cancer and its treatment. VTE incidence is increased in cancer patients, especially those undergoing chemotherapy.
  
  
  OBJECTIVE
  We sought to investigate the value of pretreatment HDL-C in the risk prediction of future VTE in a population of ambulatory cancer patients undergoing chemotherapy.
  
  
  METHODS
  Blood lipid composition was retrospectively evaluated in 592 consecutive patients with primary (n = 373) or relapsing/recurrent (n = 219) solid cancers at the start of a new chemotherapy regimen (12% neoadjuvant, 31% adjuvant, 57% metastatic).
  
  
  RESULTS
  VTE occurred during chemotherapy in 38 patients (median time-to-event: 3 months). Mean HDL-C levels were lower in patients who developed VTE during chemotherapy (41 mg dL(-1) ; standard deviation [SD] 13 mg dL(-1) ) than in those who did not (48 mg dL(-1) ; SD 14 mg dL(-1) ). Cox proportional hazard survival analysis showed that HDL-C levels ≤ 43 mg dL(-1) were able to significantly predict a first VTE episode, with a hazard ratio of 2.87 (95% confidence interval 1.45-5.68). Moreover, patients with HDL-C levels ≤ 43 mg dL(-1) had worse 1-year VTE-free survival (86%) than those with HDL-C levels > 43 mg dL(-1) (96%; log rank test, 3.14).
  
  
  CONCLUSIONS
  Patients with low HDL-C levels have a three-fold higher risk of developing a first VTE episode during chemotherapy. Baseline analysis of HDL-C levels might be of clinical value in predicting VTE in cancer outpatients treated with anticancer drugs.
authors.affiliation: Biomarker Discovery and Advanced Biotechnology (BioDAT) Laboratory, IRCCS San Raffaele Pisana, Research Center, Rome, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Ferroni
authors.forename: M
authors.initials: M
authors.lastname: Roselli
authors.forename: S
authors.initials: S
authors.lastname: Riondino
authors.forename: F
authors.initials: F
authors.lastname: Guadagni
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D008076:Cholesterol, HDL / Q000097:blood*; D018572:Disease-Free Survival; D050171:Dyslipidemias / Q000097:blood; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009369:Neoplasms / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000097:blood* / Q000150:complications
chemical_list: D000970:Antineoplastic Agents; D008076:Cholesterol, HDL
keywords: HDL cholesterol; cancer; chemotherapy; risk; venous thromboembolism