Hypocholesterolaemia and mortality in patients with coronary artery disease.

Ndrepepa, Gjin; Holdenrieder, Stefan; Cassese, Salvatore; Xhepa, Erion; Fusaro, Massimiliano; Kastrati, Adnan

doi:10.1111/eci.13194

2020

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Title:: Hypocholesterolaemia and mortality in patients with coronary artery disease.
Document type:: Article; Journal Article
Author(s):: Ndrepepa, Gjin; Holdenrieder, Stefan; Cassese, Salvatore; Xhepa, Erion; Fusaro, Massimiliano; Kastrati, Adnan
Abstract:: BACKGROUND: The association between hypocholesterolaemia and outcome of patients with coronary artery disease (CAD) remains controversial. We undertook this study to investigate whether there is an association between spontaneous or under statin therapy occurring hypocholesterolaemia and mortality in patients with CAD. MATERIALS AND METHODS: This study included 14 952 patients with CAD undergoing percutaneous coronary intervention (PCI). Hypocholesterolaemia was defined as a total cholesterol (TC) <157 mg/dL (the upper limit of 1st quintile of TC). The study outcome was all-cause mortality at 30 days and 3 years after PCI. RESULTS: Patients are categorized in four groups according to TC and statin therapy on admission: statin-naïve patients with hypocholesterolaemia (n = 1102), statin-naïve patients without hypocholesterolaemia (n = 7490), statin-treated patients with hypocholesterolaemia (n = 1824) and statin-treated patients without hypocholesterolaemia (n = 4536). In these groups, 30-day all-cause deaths occurred in 3.7%, 1.4%, 1.2% and 0.6% of the patients, respectively; 3-year deaths occurred in 18.0%, 8.4%, 10.9% and 7.2%, of the patients, respectively. After adjustment, hypocholesterolaemia remained independently associated with 30-day (adjusted hazard ratio [HR] = 1.50, 95% confidence interval [CI] 1.07 to 2.09; P < 0001) and 3-year (HR = 1.29 [1.12-1.47]; P < .001) mortality. Statin therapy on admission was independently associated with 30-day (HR = 0.61 [0.43-0.86]; P = .012) and 3-year (HR = 0.82 [0.72-0.94]; P = .017) mortality with no statin-by-cholesterol interaction with respect to 30-day (adjusted Pint = 0.669) or 3-year (adjusted Pint = 0.767) all-cause mortality suggesting that statins reduce the risk of mortality irrespective of cholesterol level. CONCLUSIONS: In patients with CAD, hypocholesterolaemia on admission was independently associated with increased risk of all-cause mortality at 30 days and 3 years after PCI.
Journal title abbreviation:: Eur J Clin Invest
Year:: 2020
Journal volume:: 50
Journal issue:: 2
Fulltext / DOI:: doi:10.1111/eci.13194
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/31863458
Print-ISSN:: 0014-2972
TUM Institution:: Institut für Laboratoriumsmedizin (keine SAP-Zuordnung!); Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (Prof. Schunkert)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Institut für Laboratoriumsmedizin (DHM) (Prof. Holdenrieder)2020

mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)2020