HDL-C levels and revascularization procedures in coronary heart disease patients treated with statins to target LDL-C levels.

Background: A low level of high-density lipoprotein cholesterol (HDL-C) is a strong predictor for cardiovascular disease morbidity and mortality at all low-density lipoprotein cholesterol (LDL-C) concentrations.

Hypothesis: We evaluated this association in routine clinical practice among statin-treated coronary heart disease patients who achieved LDL-C target levels. This association also exists in routine clinical practice.

Methods: A retrospective dynamic cohort included all male coronary heart disease patients of the Sharon-Shomron district, Clalit Health Services, Israel, with LDL-C levels < 100 mg/dL and who were receiving statins (≥ 6 purchases/y) from January 1998 to June 2008. Data were collected on demographic variables; coexistence of hypertension, diabetes mellitus, and peripheral vascular diseases; details of revascularization procedures; and lipid levels. The outcome variable was revascularization procedure, by either percutaneous intervention or coronary artery bypass graft.

Results: The study group of 909 male patients was stratified into quintiles, based on mean HDL-C levels: Q1 (n = 179): ≤ 26.4 mg/dL; Q2 (n = 190): 26.4-≤ 30.0 mg/dL; Q3 (n = 191): > 30.0-≤ 34.0 mg/dL; Q4 (n = 186): > 34.0-≤ 41.0 mg/dL; Q5 (n = 163): > 41.0 mg/dL. During the study period, 307 (33.8%) of the cohort required ≥ 1 revascularization procedure. Those in the highest quintile underwent significantly fewer procedures (40.8% for Q1 vs 16.6% for Q5, P<0.001). This significant effect of the highest HDL-C quintile was not influenced by any variable.

Conclusions: The protective effect of high HDL-C levels, regardless of other risk factors, in preventing revascularization procedures was confirmed in the routine clinical practice among statin-treated CHD patients who reached LDL-C level < 100 mg/dL. Possible additional benefits of using agents to raise HDL-C levels should be investigated.