Impact of low high-density lipoprotein-cholesterol level on 2-year clinical outcomes after acute myocardial infarction in patients with diabetes mellitusReport as inadecuate

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Lipids in Health and Disease

, 15:197

First Online: 18 November 2016Received: 12 September 2016Accepted: 11 November 2016


BackgroundIt is still unclear whether low high-density lipoprotein cholesterol HDL-C affects cardiovascular outcomes after acute myocardial infarction AMI, especially in patients with diabetes mellitus.

MethodsA total of 984 AMI patients with diabetes mellitus from the DIabetic Acute Myocardial InfarctiON Disease DIAMOND Korean multicenter registry were divided into two groups based on HDL-C level on admission: normal HDL-C group HDL-C ≥ 40 mg-dL, n = 519 and low HDL-C group HDL-C < 40 mg-dL, n = 465. The primary endpoint was 2-year major adverse cardiovascular events MACE, defined as a composite of cardiac death, non-fatal myocardial infarction MI, and target vessel revascularization TVR.

ResultsThe median follow-up duration was 730 days. The 2-year MACE rates were significantly higher in the low HDL-C group than in the normal HDL-C group MACE, 7.44% vs. 3.49%, p = 0.006; cardiac death, 3.72% vs. 0.97%, p = 0.004; non-fatal MI, 1.75% vs. 1.55%, p = 0.806; TVR, 3.50% vs. 0.97%, p = 0.007. Kaplan-Meier analysis revealed that the low HDL-C group had a significantly higher incidence of MACE compared to the normal HDL-C group log-rank p = 0.013. After adjusting for conventional risk factors, Cox proportional hazards analysis suggested that low HDL-C was an independent risk predictor for MACE hazard ratio HR 3.075, 95% confidence interval CI 1.034-9.144, p = 0.043.

ConclusionsIn patients with diabetes mellitus, low HDL-C remained an independent risk predictor for MACE after adjusting for multiple risk factors during 2-year follow-up of AMI.

Trial registrationThis study was the sub-analysis of the prospective multi-center registry of DIAMOND Diabetic acute myocardial infarction Disease in Korea. This is the observational study supported by Bayer HealthCare, Korea. Study number is 15614. First patient first visit was 02 April 2010 and last patient last visit was 09 December 2013.

KeywordsHigh-density lipoprotein cholesterol Major adverse cardiovascular events Acute myocardial infarction Diabetes mellitus AbbreviationsAMIAcute myocardial infarction

AUCArea under the curve

BMIBody mass index

CIConfidence interval

CKDChronic kidney disease

CK-MBCreatine kinase-MB fraction

DIAMONDDIabetic acute myocardial InfarctiON disease

HbA1cHemoglobin A1c

HDL-CHigh-density lipoprotein cholesterol

HRHazard ratio

hsCRPHigh-sensitivity C-reactive protein

LDL-CLow-density lipoprotein cholesterol

LVEFLeft ventricular ejection fraction

MACEMajor adverse cardiovascular events

MIMyocardial infarction

PCIPercutaneous coronary intervention

ROCReceiver operating characteristic

STEMIST-segment elevation myocardial infarction

TNTTreating to new targets

TVRTarget vessel revascularization

Electronic supplementary materialThe online version of this article doi:10.1186-s12944-016-0374-5 contains supplementary material, which is available to authorized users.

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Author: Hyung Joon Joo - Sang-A Cho - Soon Jun Hong - Seung-Ho Hur - Jang-Ho Bae - Dong-Ju Choi - Young-Keun Ahn - Jong-Seon Par


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