20 Nov HDL Levels in Acute Coronary Syndrome May Reflect Inflammatory Response
Dr. González-Pacheco
MedicalResearch.com Interview with:
Dr. Héctor González-Pacheco MD
Coronary Care Unit, National Institute of Cardiology
Mexico City, Mexico
Medical Research: What is the background for this study?
Dr. González-Pacheco: Epidemiological studies have provided robust evidence for an inverse correlation between plasma levels of high-density lipoprotein cholesterol (HDL-C) and cardiovascular risk. At hospital admission, a high percentage of patients with an acute coronary syndrome (ACS) have low HDL-C levels. Currently, the association of very low levels of HDL-C with early mortality in patients with ACS is still a topic of considerable interest. However, the possible mechanisms are not clear. Since an acute coronary syndrome induces an inflammatory response, and several chronic systemic diseases and acute critical illnesses with clear pro-inflammatory components have been associated with significantly reduced HDL-C levels, and investigators have shown an inverse correlation between HDL-C levels and the levels of pro-inflammatory cytokines, we hypothesized that reduced HDL-C levels in acute coronary syndrome might be associated to inflammatory mediators. We therefore sought to evaluate the correlation between HDL-C levels and biomarkers of inflammation available in routine laboratory screenings (high-sensitivity C-reactive protein (hs-CRP), white blood cell (WBC) count, and serum albumin) in a retrospective cross-sectional study of patients with ST-elevation myocardial infarction (STEMI) or non-ST-elevation ACS (NSTE-ACS).
Medical Research: What are the main findings?
Dr. González-Pacheco: We found that approximately one-fifth of patients had very low HDL-C levels (<30 mg/dL). Baseline levels of hs-CRP were significantly higher in these patients than in those with low (30–39.9 mg/dL) and normal (≥40 mg/dL) HDL-C levels. In contrast, serum albumin values were lower in patients with very low HDL-C levels. WBC count did not differ significantly. Accordingly, hs-CRP levels ≥ 10 mg/L and serum albumin levels ≤ 3.5 mg/dL, were two strong independent predictors of very low HDL-C levels. We observed that patients with STEMI had higher expression of biomarkers of inflammation and lower levels of HDL-C, compared with NSTE-ACS patients, as well as a lack of significant difference in the extent of coronary disease among the categories of HDL-C levels. These findings suggest that the fall in HDL-C levels is in accordance with the severity of the inflammatory response and the extent of the myocardial damage. Our findings are consistent with previous studies, in which patients with very low HDL levels had a higher rate of in-hospital mortality compared with those of other HDL-C levels.
Medical Research: What should clinicians and patients take away from your report?
Dr. González-Pacheco: Our findings support the hypothesis that the association of very low levels of HDL-C with adverse short-term prognosis in patients with ACS may not be a direct effect of, but related to, a serious inflammatory state. Evidence indicates that HDL-C is a critical component of the acute phase response. Along with hs-CRP and other biomarkers of inflammation, HDL levels could be reflecting the intensity of the inflammatory response and thus may also be used to identify a high-risk group for recurrent events in patients after an ACS.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. González-Pacheco: Future research should focus on testing the association between very low levels of HDL-C and the inflammatory response in patients with acute coronary syndrome , and on identifying those patients in whom low HDL-C levels are influenced by, or related to, an active inflammatory state. Moreover, it is also important to determine if there is an association between different subclasses of HDL-C and biomarkers of inflammation. Thus, understanding the role of HDL-C in inflammation may lead to new therapeutic approaches. Studies suggest that treatment of rheumatoid arthritis with anti-tumour necrosis factor α improves lipid levels, plausibly representing a predictable response to a reduction of inflammation. Current research with an interleukin-1 receptor antagonist in patients with ACS (MRC-ILA Heart Study) will probably shed more light on whether decreasing biomarkers of inflammation is accompanied by a positive effect on lipoprotein levels.
Citation:
Levels of High-Density Lipoprotein Cholesterol are Associated With Biomarkers of Inflammation in Patients With Acute Coronary Syndrome
González-Pacheco, Héctor et al.
American Journal of Cardiology , Volume 116 , Issue 11 , 1651 – 1657
DOI: http://dx.doi.org/10.1016/j.amjcard.2015.09.009
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Dr. Héctor González-Pacheco MD (2015). HDL Levels in Acute Coronary Syndrome May Reflect Inflammatory Response
Last Updated on November 20, 2015 by Marie Benz MD FAAD