title: Pro-oxidant HDL predicts poor outcome in patients with ST-elevation acute coronary syndrome.
abstract: Oxidative stress affects clinical outcome in patients with ST-elevation acute coronary syndrome (STE-ACS). Although high-density lipoprotein (HDL) particles are generally considered protective, deleterious properties of HDL have been observed in patients with acute myocardial infarction. Here, we analysed the association between pro-oxidant HDL and all-cause mortality in STE-ACS patients. We determined the antioxidant function of HDL in 247 prospectively enrolled patients undergoing primary percutaneous coronary intervention for STE-ACS. Patients were stratified as by a pro-oxidant serum HDL oxidant index (HOI≥ 1) or with an antioxidant serum HOI (HOL< 1) capacity. Multivariate regression analysis was used to relate HOI to survival. The median follow-up time was 23 months (IQR 14.4-40.0 months). Pro-oxidant HDL was observed in 44.1 % of STE-ACS patients and was independently associated with all-cause mortality with a hazard ratio of 3.30(95 %CI 1.50-7.27, p = 0.003). Mortality rates were higher in patients with baseline pro-oxidant HDL compared to patients with preserved HDL function at 30 days (11.9 % vs 2.2 %, p=0.002), and at 4 years (22.9 % vs 8.7 %, p=0.002). Elevated neutrophil counts were a strong and independent predictor for pro-oxidant HDL with an odds ratio per standard deviation of 1.50 (95 %CI 1.11-2.03, p=0.008), as was history of prior acute myocardial infarction, elevated triglycerides levels and reduced glomerular filtration rate. In conclusion, pro-oxidant HDL represents a strong and independent predictor of long-term as well as short-term all-cause mortality in STE-ACS patients. Elevated neutrophil counts predicted the presence of serum pro-oxidant HDL. The maintenance of HDL functions might be a promising therapeutic target in STE-ACS patients.
authors.forename: Klaus
authors.initials: K
authors.lastname: Distelmaier
authors.forename: Lore
authors.initials: L
authors.lastname: Schrutka
authors.forename: Veronika
authors.initials: V
authors.lastname: Seidl
authors.forename: Max  P
authors.initials: M
authors.lastname: Winter
authors.forename: Raphael
authors.initials: R
authors.lastname: Wurm
authors.forename: Andreas
authors.initials: A
authors.lastname: Mangold
authors.forename: Thomas
authors.initials: T
authors.lastname: Perkmann
authors.forename: Gerald
authors.initials: G
authors.lastname: Maurer
authors.forename: Christopher
authors.initials: C
authors.lastname: Adlbrecht
authors.affiliation: Irene Lang, MD, Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Waehringer Guertel 18-20, A-1090 Vienna, Austria, Tel.: +43 1 40400 46140, Fax: +43 1 40400 42160, E-mail: irene.lang@meduniwien.ac.at.
authors.forename: Irene M
authors.initials: IM
authors.lastname: Lang
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D000368:Aged; D000975:Antioxidants / Q000378:metabolism*; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D008075:Lipoproteins, HDL / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D009504:Neutrophils; D016017:Odds Ratio; D018384:Oxidative Stress; D062645:Percutaneous Coronary Intervention; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000975:Antioxidants; D015415:Biomarkers; D008075:Lipoproteins, HDL
keywords: HDL; STE-ACS; antioxidant function; outcome