The Prediction Value Of Serum High-density Lipoprotein Cholesterol And Its Subclasses For The Prognosis Of Patients With Coronary Heart Disease

Objective To explore the prediction value of high-density lipoprotein cholesterol(HDL-C) and its subclasses for the occurrence of cardiovascular events in patients with coronary heart disease(CHD).285 CHD patients in the first affiliated hospital of anhui medical university were followed-up.Methods 285 cases with CHD in the first affiliated hospital of anhui medical university were enrolled in this study, with baseline of HDL-C and its subtypes HDL2-C and HDL3-C tasted and then being followed up 1482 days(4.12 years) in median. Cardiovascular events in this study included total events, the primary end point, all-cause mortality(all-cause mortality, nonfatal MI, nonfatal stroke), the primary end point, cardiac death(cardiac death, nonfatal MI, nonfatal stroke) and secondary end point events(revascularization and grade IV heart failure).Cox regression and Kaplan-Meier curve analysis were used to analyze the relationship of baseline of HDL-C and its subclass level with the risk of these events. SPSS 16.0 was used for all statistical analyses. All statistical tests were two-sided and P<0.05 was regarded as statistically significant.Results 1. General data contrast showed that age of event group were significantly higher than no event group(67 + 11 vs 63 + 11 years old, p = 0.010), HDL2-C content was lower than that in group without events(0.54±0.21 vs 0.61±0.23 mmol/l, p=0.018), the differences were statistically significant.Other clinical baseline datas have no statistical significance.2. COX regression showed that HDL-C, HDL3-C have no significant predictive value for end point events of patients with CHD. While HDL2-C have predictive value for total events(HR = 0.27, 95% CI 0.077 0.949, P = 0.041), the primary end point, all-cause mortality(HR = 0.419, 95% CI 0.211 0.831, P = 0.013), the primary end point, cardiac death(HR = 0.125, 95% CI 0.019 0.833, P = 0.032), cardiac death(HR = 0.042, 95% CI 0.002 0.804, P = 0.035), the secondary end points(HR = 0.466, 95% CI 0.235 0.924, P = 0.029). The higher content of HDL2-C was, the lower risk of its end point events.3. The cases were divided the into two groups by the median of HDL2-C(0.56 mmol/l). The results showed that when compared with HDL2-C>0.56 mmol/l group, the HDL2-C≤0.56 mmol/l group has more total events, the primary end point cardiac death, cardiac death and secondary end points. Differences were statistically significant.The Kaplan-Meier curve also showed the similar conclusions.4. When excluding the interference of some other covariates, COX regression showed that HDL2-C can predict total events(HR = 0.425, 95% CI 0.252 0.717, P = 0.001), the primary end point, all-cause mortality(HR = 0.419, 95% CI 0.211 0.831, P = 0.013), the primary end point, cardiac death(HR = 0.321, 95% CI 0.148 0.694, P = 0.004), cardiac death(HR = 0.290, 95% CI 0.090 0.939, P = 0.039) and the secondary end point(HR = 0.466, 95% CI 0.235 0.924, P = 0.029). Among them it has the highest predictive value for cardiac death. Patients with HDL2-C above the median have significantly lower risk of each end point event.ConclusionHDL-C and its subtypes HDL3-C have no significant predictive value of end point events in patients with CHD;while the levels of serum HDL2-C has predictive value for the prognosis of patients with CHD.Patients with increased HDL2-C content have lower risk of total end point events, the primary end point events and the secondary end point events.Among them, the predictive value of cardiac death is the largest.