title: Gender-related impact on outcomes of high density lipoprotein in acute ST-elevation myocardial infarction.
abstract: There is rising evidence that cardioprotective functions of high-density lipoprotein (HDL) have significant impact on clinical outcomes. ST-elevation myocardial infarction (STEMI) represents a high-risk vascular condition. Whether higher HDL-cholesterol concentrations in women correspond to protective anti-oxidant properties in the setting of STEMI is unknown.
  
  
  
  We prospectively assessed gender related differences in the anti-oxidant function of HDL, and the impact of HDL properties on mortality in 242 women and men with STEMI. Blood samples to determine HDL function and sex hormone levels were collected during primary percutaneous coronary intervention.
  
  
  
  Patients were stratified according to preserved anti-oxidant HDL function (HDL oxidant index (HOI) < 1) and pro-oxidant HDL (HOI≥1). Despite higher serum levels of HDL-cholesterol in postmenopausal women (48 mg/dl, IQR 42-54, versus 39 mg/dl, IQR33-47, p < 0.001 in men), the proportion of patients with pro-oxidant HDL was not different between women (35%) and men (46%, p = 0.132). Kaplan-Meier analysis revealed higher cardiovascular mortality in both women (p = 0.021) and men (p = 0.045) with pro-oxidant HDL. We identified pro-oxidant HDL as strong and independent predictor of cardiovascular mortality with an adjusted HR of 8.33 (95% CI, 1.55-44.63; p = 0.013) in women and with an adjusted HR of 5.14 (95% CI, 1.61-16.42; p = 0.006) in men. Higher levels of free sex hormones (estradiol and testosterone) were associated with pro-oxidant HDL. HDL-cholesterol levels showed no association with mortality (HR in women 1.03, 95% CI 0.96-1.11, p = 0.45 and HR in men 0.99, 95% CI 0.94-1.05, p = 0.72).
  
  
  
  Total HDL-cholesterol serum levels were not associated with mortality in STEMI patients. Pro-oxidant HDL was a strong and independent predictor of mortality in women and men with STEMI. The present study provides a link between sex hormones, HDL function and clinical events in STEMI patients. In clinical practice and future clinical trials, anti-oxidant properties of HDL rather than total HDL serum levels should be used for risk stratification.
authors.affiliation: Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria.
authors.forename: K
authors.initials: K
authors.lastname: Distelmaier
authors.affiliation: Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria.
authors.forename: L
authors.initials: L
authors.lastname: Schrutka
authors.affiliation: Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Wurm
authors.affiliation: Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria.
authors.forename: V
authors.initials: V
authors.lastname: Seidl
authors.affiliation: Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria.
authors.forename: H
authors.initials: H
authors.lastname: Arfsten
authors.affiliation: Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Cho
authors.affiliation: Division of Endocrinology and Metabolism, Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: S
authors.initials: S
authors.lastname: Manjunatha
authors.affiliation: Department of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria.
authors.forename: T
authors.initials: T
authors.lastname: Perkmann
authors.affiliation: Complexity-Research, Research Institute for Complex Systems, Vienna, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Strunk
authors.affiliation: Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria. Electronic address: irene.lang@meduniwien.ac.at.
authors.forename: I M
authors.initials: IM
authors.lastname: Lang
authors.affiliation: Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria; 4th Medical Department, Hietzing Hospital, Vienna, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Adlbrecht
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000975:Antioxidants / Q000378:metabolism; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D005260:Female; D006801:Humans; D008075:Lipoproteins, HDL / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood*; D016877:Oxidants / Q000737:chemistry; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D017382:Reactive Oxygen Species / Q000378:metabolism; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013739:Testosterone / Q000097:blood; D016896:Treatment Outcome
chemical_list: D000975:Antioxidants; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D008075:Lipoproteins, HDL; D016877:Oxidants; D017382:Reactive Oxygen Species; D013739:Testosterone
keywords: Acute myocardial infarction; Gender; High density lipoprotein; Outcome; Sex hormones