Lower TC:HDL, LDL tied to higher mortality rates in patients with ACS
Lower total cholesterol-to-high density lipoprotein cholesterol ratio (TC:HDL) and low-density lipoprotein (LDL) levels appear to be associated with elevated mortality rates in patients with acute coronary syndrome (ACS), according to a study presented at the 21st Asian Pacific Society of Cardiology Congress (APSC 2017) held in Singapore.
Using data from Hospital Sungai Buloh, Selangor, Malaysia, researchers conducted a prospective, observational study involving 1,479 patients with ACS (mean age 56 years, 70.8 percent male), 56.6 percent (n=837) of whom had LDL levels ≥2.6 mmol/L. About 46 percent had unstable angina, 29.6 percent had non-ST elevation myocardial infarction (NSTEMI), and 24.5 percent had STEMI. [APSC 2017, abstract P157]
Mean total cholesterol, HDL, LDL, and triglyceride levels were 5.65, 1.02, 3.07, and 1.86 mmol/L, respectively.
Compared with higher TC:HDL ratio (≥3.5 mmol/L), patients with lower TC:HDL (<3.5 mmol/L) had a higher 30-day mortality rate (17.5 percent vs 4.7 percent).
Patients with lower LDL levels (<2.6 mmol/L) also had a higher 30-day mortality rate (11 percent vs 4.5 percent; p<0.005) and risk of NSTEMI (34.2 percent vs 28.3 percent) than those who had higher LDL (≥2.6 mmol/L).
On the other hand, a higher risk of STEMI was observed in patients with higher LDL compared with lower LDL levels (23.7 percent vs 16.7 percent).
The results also showed that hypertension was the most common risk factor for ACS (65.9 percent), followed by diabetes mellitus (48.5 percent), ischaemic heart disease (42.7 percent), and dyslipidaemia (29.3 percent) as well as smoking (27.9 percent).
“Interestingly, lipid profile was not an independent mortality predictor in our cohort,” according to lead author Dr Affida Ahmad from the Department of Cardiology at Universiti Teknology Mara in Sungai Buloh.Although most patients with ACS typically have higher levels of LDL, the higher mortality rate and risk of NSTEMI in the lower LDL group in this study emphasizes the significance of managing the associated risk factors of ACS concurrently, Ahmad added.