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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, 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 the citing paper
“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 the citing paper
“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 the citing paper
“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]
In the citing paper
“CETP inhibition probably also extends the lifespan of dysfunctional HDL.”
From HDL cholesterol: reappraisal of its clinical relevance (2017) · cites this paper as [74]
In the citing paper
“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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Metadata
- 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 › Cardiology and Cardiovascular Medicine › 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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