Relationship between Discordance of Low-Density Lipoprotein and Non-High-Density Lipoprotein Cholesterol and Risk Stratification in Acute Myocardial Infarction

Eren, Murat; Kurmus, Ozge; Aslan, Turgay; Akbuga, Kursat; Tolunay, Hatice

doi:10.36660/ijcs.20200172

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International Journal of Cardiovascular Sciences

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Original Article • Int. J. Cardiovasc. Sci. 34 (5) • Sep-Oct 2021 • https://doi.org/10.36660/ijcs.20200172 copy

Relationship between Discordance of Low-Density Lipoprotein and Non-High-Density Lipoprotein Cholesterol and Risk Stratification in Acute Myocardial Infarction

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Sizeable proportion of patients have discordant low-density lipoprotein cholesterol (LDL-C) and non-high density lipoprotein cholesterol (NHDL-C). It has been shown that discordance of LDL-C and NHDL-C either underestimates or overestimates coronary risk.

Objectıve:

We assessed whether this discordance has an impact on GRACE and TIMI risk scores in patients with acute myocardial infarction (AMI).

Methods:

We retrospectively evaluated the data of 198 consecutive patients with AMI. Fasting serum lipid profiles were recorded, GRACE and TIMI scores were calculated. Patients were divided into 3 groups according to LDL-C and NHDL-C percentiles: Discordant group: LDL-C<NHDL-C (n=38), concordant group: LDL-C=NHDL-C (n=112) and discordant group LDL-C>NHDL-C (n=48). GRACE and TIMI scores, mortality and cardiovascular events (heart failure, non-fatal myocardial infarction and angina) at sixth month were compared between these three groups. Differences between these groups were analyzed with One-way ANOVA or Kruskal-Wallis rank test, and with chi-square for percentages. Also, post hoc LSD or Conover-Iman's non-parametric multiple comparison test were used. A p value <0.05 was accepted as statistically significant.

Results:

TIMI risk score didn't differ between discordant or concordant groups. Mean GRACE (death) and GRACE (death and MI) scores were higher in group with LDL-C<NHDL-C than with LDL-C=NHDL-C and LDL-C>NHDL-C (p=0.029 and 0.008, respectively). Cardiovascular events and mortality at sixth month were not different among groups (p=0.473 and p=0.176, respectively).

Conclusion:

GRACE score was higher in discordant group with LDL-C<NHDL-C, but there is no difference regarding TIMI scores between discordant and concordant groups in AMI patients.

Keywords:
Atherosclerosis; Low Density Lipoprotein Receptor –Related Protein; Cholesteroç-HDL; Triglycerides; Cardiovascular Diseases/complications

Characteristics
Clinical characteristics
Gender (% male)	73.7
Age (years) (mean±standart deviation)	62.7±10.7
Smoking (%)	61.6
Hypertension (%)	60.6
Diabetes (%)	30.3
Dyslipidemia (%)	37.9
Body mass index (kg/m²) (mean±standart deviation)	26.8±4.1

Biochemical analysis (mean±standart deviation)
Total cholesterol (mg/dl)	185.8±41.4
LDL-C (mg/dl)	116.7±33.3
HDL-C (mg/dl)	37.1±9.8
Triglyceride (mg/dl)	162.7±112.9
NHDL-C (mg/dl)	148.6±40.1
Fasting glucose (mg/dl) glucose(mg/dl)	116.6±42.1
Creatinine (mg/dl)	1.1±0.55

Risk scores (mean±standart deviation)
Mean GRACE (death) score	110.2±29.2
Mean GRACE (death and MI) score	124.3±44.0
Median TIMI score (interquartile range)	3.0(2.0)

	LDL-C<NHDL-C n=38 (group 1)	LDL-C=NHDL-C n=112 (group 2)	LDL-C>NHDL-C n=48 (group 3)	p
Age (years) ^* * One Way Anova	58.9±9.3	63.5±11.1	63.7±10.4	0.054
Gender (% male)^β β Chi-square. LSD or Conover-Iman test was performed for the binary comparisons among the groups and the p value was set at 0.05. Significant differences were found between	73.7	70.5	81.3	0.369
Smoking (%)^β β Chi-square. LSD or Conover-Iman test was performed for the binary comparisons among the groups and the p value was set at 0.05. Significant differences were found between	68.4	57.1	66.7	0.331
Hypertension (%)^β β Chi-square. LSD or Conover-Iman test was performed for the binary comparisons among the groups and the p value was set at 0.05. Significant differences were found between	60.5	64.3	52.1	0.351
Diabetes (%)^β β Chi-square. LSD or Conover-Iman test was performed for the binary comparisons among the groups and the p value was set at 0.05. Significant differences were found between	50.0	25.9	25.0	0.013 ^a a group 1 vs group 2 ,^b b group 1 vs group 3
Dyslipidemia (%)^β β Chi-square. LSD or Conover-Iman test was performed for the binary comparisons among the groups and the p value was set at 0.05. Significant differences were found between	50.0	35.7	33.3	0.221
Body mass index (kg/m²) ^* * One Way Anova	27.9±6.2	26.2±4.5	25.1±4.1	0.376
Total cholesterol (mg/dl) ^* * One Way Anova	200.8±40.5	182.8±44.7	180.9±30.8	0.044 ^a a group 1 vs group 2 ,^b b group 1 vs group 3
LDL-C (mg/dl)^δ δ Kruskal Wallis	105.2(46.0)	115.7(46.8)	121.8(40.2)	0.053
HDL-C (mg/dl)^δ δ Kruskal Wallis	30.0(6.0)	35.0(9.0)	42.0(17.0)	<0,001^a a group 1 vs group 2 ,^b b group 1 vs group 3 ,^c c group 2 vs group 3. Statistically significant p-values are in bold.
Triglyceride ^* * One Way Anova	321.2±164.9	140.1±43.8	90.0±24.6	<0.001^a a group 1 vs group 2 ,^b b group 1 vs group 3 ,^c c group 2 vs group 3. Statistically significant p-values are in bold.
NHDL-C (mg/dl)^δ δ Kruskal Wallis	158.5(37.0)	147.0(53.5)	141.0(42.5)	0.002 ^a a group 1 vs group 2 ,^b b group 1 vs group 3
Mean GRACE (death) *** score ^* * One Way Anova	114.5±29.5	98.7±22.1	112.0±30.3	0.029 ^a a group 1 vs group 2 ,^b b group 1 vs group 3
Mean GRACE (death and MI) **score ^δ δ Kruskal Wallis	133.4±41.5	104.3±31.1	127.0±46.9	0.008 ^a a group 1 vs group 2 ,^b b group 1 vs group 3
TIMI risk score^δ δ Kruskal Wallis	3.0(2.0)	3.0(2.0)	3.0(2.0)	0.925
In-hospital mortality (%)	1(2.6)	2(1.8)	1(2.1)	-----
Mortality at sixth month(%)^β β Chi-square. LSD or Conover-Iman test was performed for the binary comparisons among the groups and the p value was set at 0.05. Significant differences were found between	5.7	5,7	4.4	0.176
Cardiovascular events at sixth month (%)^β β Chi-square. LSD or Conover-Iman test was performed for the binary comparisons among the groups and the p value was set at 0.05. Significant differences were found between	11.2	18.4	19.6	0.473

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