High-density lipoprotein cholesterol, coronary artery disease, and cardiovascular mortality
Open accessAbstract
AIMS: High-density lipoprotein (HDL) cholesterol is a strong predictor of cardiovascular mortality. This work aimed to investigate whether the presence of coronary artery disease (CAD) impacts on its predictive value. METHODS AND RESULTS: We studied 3141 participants (2191 males, 950 females) of the LUdwigshafen RIsk and Cardiovascular health (LURIC) study. They had a mean ± standard deviation age of 62.6 ± 10.6 years, body mass index of 27.5 ± 4.1 kg/m², and HDL cholesterol of 38.9 ± 10.8 mg/dL. The cohort consisted of 699 people without CAD, 1515 patients with stable CAD, and 927 patients with unstable CAD. The participants were prospectively followed for cardiovascular mortality over a median (inter-quartile range) period of 9.9 (8.7-10.7) years. A total of 590 participants died from cardiovascular diseases. High-density lipoprotein cholesterol by tertiles was inversely related to cardiovascular mortality in the entire cohort (P = 0.009). There was significant interaction between HDL cholesterol and CAD in predicting the outcome (P = 0.007). In stratified analyses, HDL cholesterol was strongly associated with cardiovascular mortality in people without CAD [3rd vs. 1st tertile: HR (95% CI) = 0.37 (0.18-0.74), P = 0.005], but not in patients with stable [3rd vs. 1st tertile: HR (95% CI) = 0.81 (0.61-1.09), P = 0.159] and unstable [3rd vs. 1st tertile: HR (95% CI) = 0.91 (0.59-1.41), P = 0.675] CAD. These results were replicated by analyses in 3413 participants of the AtheroGene cohort and 5738 participants of the ESTHER cohort, and by a meta-analysis comprising all three cohorts. CONCLUSION: The inverse relationship of HDL cholesterol with cardiovascular mortality is weakened in patients with CAD. The usefulness of considering HDL cholesterol for cardiovascular risk stratification seems limited in such patients.
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In patients who underwent coronary angiography, the relationship of HDL-C to long-term prognosis was completely abolished in clinically unstable patients.
“In patients who underwent coronary angiography, we have observed that HDL-C correlates inversely with cardiovascular mortality in the absence of CHD, that the relationship of HDL-C to long-term prognosis was weakened in stable coronary heart disease, whereas in clinically unstable patients the relationship was completely abolished [74].”
From HDL cholesterol: reappraisal of its clinical relevance (2017) · cites this paper as [74]
In patients who underwent coronary angiography, HDL-C correlates inversely with cardiovascular mortality in the absence of CHD.
“In patients who underwent coronary angiography, we have observed that HDL-C correlates inversely with cardiovascular mortality in the absence of CHD, that the relationship of HDL-C to long-term prognosis was weakened in stable coronary heart disease, whereas in clinically unstable patients the relationship was completely abolished [74].”
From HDL cholesterol: reappraisal of its clinical relevance (2017) · cites this paper as [74]
In patients who underwent coronary angiography, the relationship of HDL-C to long-term prognosis was weakened in stable coronary heart disease.
“In patients who underwent coronary angiography, we have observed that HDL-C correlates inversely with cardiovascular mortality in the absence of CHD, that the relationship of HDL-C to long-term prognosis was weakened in stable coronary heart disease, whereas in clinically unstable patients the relationship was completely abolished [74].”
From HDL cholesterol: reappraisal of its clinical relevance (2017) · cites this paper as [74]
In patients with diabetes mellitus, coronary disease, chronic renal insufficiency, cardiovascular risk factors and disorders, the function of HDL is impaired.
“In patients with diabetes mellitus, coronary disease, chronic renal insufficiency, cardiovascular risk factors and disorders, the function of HDL is impaired [9, 61, 70–74].”
From HDL cholesterol: reappraisal of its clinical relevance (2017) · cites this paper as [74]
CETP inhibition probably also extends the lifespan of dysfunctional HDL.
“CETP inhibition probably also extends the lifespan of dysfunctional HDL.”
From HDL cholesterol: reappraisal of its clinical relevance (2017) · cites this paper as [74]
CETP inhibition may eliminate the postulated atheroprotective effect of HDL or even be harmful if HDL gained adverse properties.
“This may not only eliminate the postulated atheroprotective effect but even be harmful if HDL gained adverse properties [9, 74, 108].”
From HDL cholesterol: reappraisal of its clinical relevance (2017) · cites this paper as [74]
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- Authors
- Silbernagel, G., Schottker, B., Appelbaum, S., Scharnagl, H., Kleber, M. E., Grammer, T. B., Ritsch, A., Mons, U., Holleczek, B., Goliasch, G., Niessner, A., Boehm, B. O., Schnabel, R. B., Brenner, H., Blankenberg, S., Landmesser, U., & Marz, W.
- Affiliations
- University of Bern (CH)
- Universität Hamburg (DE)
- Medical University of Graz (AT)
- Heidelberg University (DE)
- Innsbruck Medical University (AT)
- German Cancer Research Center (DE)
- Medical University of Vienna (AT)
- Nanyang Technological University (SG)
- University of Zurich (CH)
- Corresponding author
- Silbernagel, G.
- ORCID
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-09-07
- Volume
- 34
- Issue
- 46
- Pages
- 3563-3571
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2072406176
- Cited by
- 123
- References
- 28
- Citations by year
- 2026: 1 · 2025: 7 · 2024: 6 · 2023: 7 · 2022: 9 · 2021: 12 · 2020: 12 · 2019: 8 · 2018: 8 · 2017: 13 · 2016: 8 · 2015: 13 · 2014: 19
- FWCI
- 13.46
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
- reroDoc Digital Library (submittedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion, other-oa)
- HighWire Press Open Archive (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- European Commission (201668, 305739, LSHM-CT-2004-503485)
- Bundesministerium für Bildung und Forschung
- Fondation de France (2002004994)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Paraoxonase enzyme and polymorphisms
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- HDL cholesterol, coronary artery disease, cardiovascular mortality, cardiovascular risk stratification, stable coronary artery disease, unstable coronary artery disease, LURIC study, ESTHER cohort
- MeSH terms
- Cardiovascular Diseases, Cause of Death, Coronary Artery Disease, Female, Germany, Humans, Cholesterol, HDL, Male, Middle Aged, Prognosis, Risk Factors, Cohort Studies
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