title: Low-density lipoprotein cholesterol and survival in pulmonary arterial hypertension.
abstract: Low-density lipoprotein cholesterol(LDL-C) is a well established metabolic marker of cardiovascular risk, however, its role in pulmonary arterial hypertension (PAH) has not been determined. Therefore we assessed whether LDL-C levels are altered in PAH patients, if they are associated with survival in this group and whether pulmonary hypertension (PH) reversal can influence LDL-C levels. Consecutive 46 PAH males and 94 females were age matched with a representative sample of 1168 males and 1245 females, respectively. Cox regression models were used to assess the association between LDL-C and mortality. The effect of PH reversal on LDL-C levels was assessed in 34 patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing invasive treatment. LDL-C was lower in both PAH (2.6 ± 0.8 mmol/l) and CTEPH (2.7 ± 0.7 mmol/l) patients when compared to controls (3.2 ± 1.1 mmol/l, p < 0.001). In PAH patients lower LDL-C significantly predicted death (HR:0.44/1 mmol/l, 95%CI:0.26-0.74, p = 0.002) after a median follow-up time of 33(21-36) months. In the CTEPH group, LDL-C increased (from 2.6[2.1-3.2] to 4.0[2.8-4.9]mmol/l, p = 0.01) in patients with PH reversal but remained unchanged in other patients (2.4[2.2-2.7] vs 2.3[2.1-2.5]mmol/l, p = 0.51). We concluded that LDL-C level is low in patients with PAH and is associated with an increased risk of death. Reversal of PH increases LDL-C levels.
authors.affiliation: Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital in Krakow, Krakow, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Kopeć
authors.affiliation: Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital in Krakow, Krakow, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Waligóra
authors.affiliation: Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital in Krakow, Krakow, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Tyrka
authors.affiliation: Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital in Krakow, Krakow, Poland.
authors.forename: Kamil
authors.initials: K
authors.lastname: Jonas
authors.affiliation: Duke Clinical Research Institute, Duke University, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pencina
authors.affiliation: Department of Arterial Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland.|Department-Centre of Monitoring and Analyses of Population Health, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Zdrojewski
authors.affiliation: Third Department of Internal Medicine, University Hospital St. Poelten, St. Poelten, Austria.
authors.forename: Deddo
authors.initials: D
authors.lastname: Moertl
authors.affiliation: Department-Centre of Monitoring and Analyses of Population Health, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland.
authors.forename: Jakub
authors.initials: J
authors.lastname: Stokwiszewski
authors.affiliation: Department of Hygiene and Epidemiology, Medical University of Gdańsk.
authors.forename: Paweł
authors.initials: P
authors.lastname: Zagożdżon
authors.affiliation: Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital in Krakow, Krakow, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Podolec
mesh_terms: D000328:Adult; D000367:Age Factors; D015415:Biomarkers; D016022:Case-Control Studies; D008078:Cholesterol, LDL / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL