Patients with peripheral artery disease and low HDL levels, compared with normal levels, may have a higher risk for MACE and all-cause mortality, new data suggest.
“The prognosis of patients with [PAD] is characterized by an exceptionally high risk for [MI], ischemic stroke and death; however, studies in search of new prognostic biomarkers in PAD are scarce,” the researchers wrote. “Even though low levels of [HDL] cholesterol have been associated with higher risk of [CV] complications and death in different atherosclerotic diseases, recent epidemiologic studies have challenged its prognostic utility.”
The researchers conducted a prospective, single-center study in which 254 patients (mean age, 71 years; 88% men) with symptomatic PAD were followed for an average of 2.7 years. Of these patients, 135 had reduced HDL levels and 119 had normal HDL levels.
During follow-up, 75 deaths (29%) occurred. After adjustment for age, sex and other confounding factors, the researchers found a 54% reduction in mortality among patients with normal HDL levels, compared with low levels (HR = 0.46; 95% CI, 0.21-0.99).
There were 57 incidents of MACE — a composite of amputation, ischemic coronary disease, cerebrovascular disease and all-cause mortality — among 165 patients without previous MI and cerebral ischemia. The results revealed a significantly lower risk for MACE among patients with normal HDL levels vs. low HDL levels (HR = 0.38; 95% CI, 0.16-0.86) after adjustment for multiple variables.
The researchers also assessed the relationship between HDL levels and disease severity. Using Fontaine classification, patients were categorized as having intermittent claudication (n = 139) or critical limb ischemia (n = 115). Results from multivariate analyses linked normal HDL levels with a reduction in severity of PAD after adjustment for age, sex and other CV risk factors, compared with low HDL levels (OR = 0.09; 95% CI, 0.03-0.24).
At baseline, patients with low HDL levels were more likely to have diabetes, lower ankle brachial index, higher arterial stiffness and histories of chronic kidney disease, cardiomyopathy and cerebral ischemia, as well as more frequent use of anticoagulants and beta-blockers.
“This study confirms that [HDL cholesterol] may represent an important independent prognostic biomarker of [CVD] in patients with symptomatic PAD. These findings highlight the usefulness of this simple test for early identification of PAD patients at high risk of mortality and MACE,” the researchers wrote. – by Melissa Foster
Disclosure: The authors report no relevant financial disclosures.