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The Lipid Paradox is present in ST-elevation but not in non-ST-elevation myocardial infarction patients: Insights from the Singapore Myocardial Infarction Registry

Lowering low-density lipoprotein (LDL-C) and triglyceride (TG) levels form the cornerstone approach of cardiovascular risk reduction, and a higher high-density lipoprotein (HDL-C) is thought to be protective. However, in acute myocardial infarction (AMI) patients, higher admission LDL-C and TG level...

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Autores principales: Sia, Ching-Hui, Zheng, Huili, Ho, Andrew Fu-Wah, Bulluck, Heerajnarain, Chong, Jun, Foo, David, Foo, Ling-Li, Lim, Patrick Zhan Yun, Liew, Boon Wah, Tan, Huay-Cheem, Yeo, Tiong-Cheng, Chua, Terrance Siang Jin, Chan, Mark Yan-Yee, Hausenloy, Derek J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176706/
https://www.ncbi.nlm.nih.gov/pubmed/32321961
http://dx.doi.org/10.1038/s41598-020-63825-8
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author Sia, Ching-Hui
Zheng, Huili
Ho, Andrew Fu-Wah
Bulluck, Heerajnarain
Chong, Jun
Foo, David
Foo, Ling-Li
Lim, Patrick Zhan Yun
Liew, Boon Wah
Tan, Huay-Cheem
Yeo, Tiong-Cheng
Chua, Terrance Siang Jin
Chan, Mark Yan-Yee
Hausenloy, Derek J.
author_facet Sia, Ching-Hui
Zheng, Huili
Ho, Andrew Fu-Wah
Bulluck, Heerajnarain
Chong, Jun
Foo, David
Foo, Ling-Li
Lim, Patrick Zhan Yun
Liew, Boon Wah
Tan, Huay-Cheem
Yeo, Tiong-Cheng
Chua, Terrance Siang Jin
Chan, Mark Yan-Yee
Hausenloy, Derek J.
author_sort Sia, Ching-Hui
collection PubMed
description Lowering low-density lipoprotein (LDL-C) and triglyceride (TG) levels form the cornerstone approach of cardiovascular risk reduction, and a higher high-density lipoprotein (HDL-C) is thought to be protective. However, in acute myocardial infarction (AMI) patients, higher admission LDL-C and TG levels have been shown to be associated with better clinical outcomes - termed the ‘lipid paradox’. We studied the relationship between lipid profile obtained within 72 hours of presentation, and all-cause mortality (during hospitalization, at 30-days and 12-months), and rehospitalization for heart failure and non-fatal AMI at 12-months in ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients treated by percutaneous coronary intervention (PCI). We included 11543 STEMI and 8470 NSTEMI patients who underwent PCI in the Singapore Myocardial Infarction Registry between 2008–2015. NSTEMI patients were older (60.3 years vs 57.7 years, p < 0.001) and more likely to be female (22.4% vs 15.0%, p < 0.001). In NSTEMI, a lower LDL-C was paradoxically associated with worse outcomes for death during hospitalization, within 30-days and within 12-months (all p < 0.001), but adjustment eliminated this paradox. In contrast, the paradox for LDL-C persisted for all primary outcomes after adjustment in STEMI. For NSTEMI patients, a lower HDL-C was associated with a higher risk of death during hospitalization but in STEMI patients a lower HDL-C was paradoxically associated with a lower risk of death during hospitalization. For this endpoint, the interaction term for HDL-C and type of MI was significant even after adjustment. An elevated TG level was not protective after adjustment. These observations may be due to differing characteristics and underlying pathophysiological mechanisms in NSTEMI and STEMI.
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spelling pubmed-71767062020-04-27 The Lipid Paradox is present in ST-elevation but not in non-ST-elevation myocardial infarction patients: Insights from the Singapore Myocardial Infarction Registry Sia, Ching-Hui Zheng, Huili Ho, Andrew Fu-Wah Bulluck, Heerajnarain Chong, Jun Foo, David Foo, Ling-Li Lim, Patrick Zhan Yun Liew, Boon Wah Tan, Huay-Cheem Yeo, Tiong-Cheng Chua, Terrance Siang Jin Chan, Mark Yan-Yee Hausenloy, Derek J. Sci Rep Article Lowering low-density lipoprotein (LDL-C) and triglyceride (TG) levels form the cornerstone approach of cardiovascular risk reduction, and a higher high-density lipoprotein (HDL-C) is thought to be protective. However, in acute myocardial infarction (AMI) patients, higher admission LDL-C and TG levels have been shown to be associated with better clinical outcomes - termed the ‘lipid paradox’. We studied the relationship between lipid profile obtained within 72 hours of presentation, and all-cause mortality (during hospitalization, at 30-days and 12-months), and rehospitalization for heart failure and non-fatal AMI at 12-months in ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients treated by percutaneous coronary intervention (PCI). We included 11543 STEMI and 8470 NSTEMI patients who underwent PCI in the Singapore Myocardial Infarction Registry between 2008–2015. NSTEMI patients were older (60.3 years vs 57.7 years, p < 0.001) and more likely to be female (22.4% vs 15.0%, p < 0.001). In NSTEMI, a lower LDL-C was paradoxically associated with worse outcomes for death during hospitalization, within 30-days and within 12-months (all p < 0.001), but adjustment eliminated this paradox. In contrast, the paradox for LDL-C persisted for all primary outcomes after adjustment in STEMI. For NSTEMI patients, a lower HDL-C was associated with a higher risk of death during hospitalization but in STEMI patients a lower HDL-C was paradoxically associated with a lower risk of death during hospitalization. For this endpoint, the interaction term for HDL-C and type of MI was significant even after adjustment. An elevated TG level was not protective after adjustment. These observations may be due to differing characteristics and underlying pathophysiological mechanisms in NSTEMI and STEMI. Nature Publishing Group UK 2020-04-22 /pmc/articles/PMC7176706/ /pubmed/32321961 http://dx.doi.org/10.1038/s41598-020-63825-8 Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Article
Sia, Ching-Hui
Zheng, Huili
Ho, Andrew Fu-Wah
Bulluck, Heerajnarain
Chong, Jun
Foo, David
Foo, Ling-Li
Lim, Patrick Zhan Yun
Liew, Boon Wah
Tan, Huay-Cheem
Yeo, Tiong-Cheng
Chua, Terrance Siang Jin
Chan, Mark Yan-Yee
Hausenloy, Derek J.
The Lipid Paradox is present in ST-elevation but not in non-ST-elevation myocardial infarction patients: Insights from the Singapore Myocardial Infarction Registry
title The Lipid Paradox is present in ST-elevation but not in non-ST-elevation myocardial infarction patients: Insights from the Singapore Myocardial Infarction Registry
title_full The Lipid Paradox is present in ST-elevation but not in non-ST-elevation myocardial infarction patients: Insights from the Singapore Myocardial Infarction Registry
title_fullStr The Lipid Paradox is present in ST-elevation but not in non-ST-elevation myocardial infarction patients: Insights from the Singapore Myocardial Infarction Registry
title_full_unstemmed The Lipid Paradox is present in ST-elevation but not in non-ST-elevation myocardial infarction patients: Insights from the Singapore Myocardial Infarction Registry
title_short The Lipid Paradox is present in ST-elevation but not in non-ST-elevation myocardial infarction patients: Insights from the Singapore Myocardial Infarction Registry
title_sort lipid paradox is present in st-elevation but not in non-st-elevation myocardial infarction patients: insights from the singapore myocardial infarction registry
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176706/
https://www.ncbi.nlm.nih.gov/pubmed/32321961
http://dx.doi.org/10.1038/s41598-020-63825-8
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