IMPACT OF PLASMA HDL CHOLESTEROL LEVELS, MEASURED ONE YEAR BEFORE ACUTE MYOCARDIAL INFARCTION, ON MORTALITY AFTER THE ACUTE EVENT

Introduction: Although epidemiological studies demonstrated that HDL cholesterol (HDL-C) levels are associated with higher cardiovascular risk, pharmacological interventions for elevated HDL-C levels have failed to show a risk reduction. Objective: To evaluate patients admitted for acute myocardial infarction (AMI) to determine whether HDL-C levels measured up to 1 year before the event have an impact on post-event mortality. Methods: A retrospective cohort study was conducted using data from the database of the Curitiba (Brazil) city hall. This study included 1,363 patients hospitalized from 2008 to 2015, with a diagnosis of infarction and available HDL-C values measured up to 1 year before the coronary event. The mean HDL-C levels obtained in this period and at 6 and 12 months after discharge were correlated with hospital mortality. Results: HDL-C levels of ≤35 mg/dL resulted in lower mortality than values of ≥50 mg/dL. This indicates that the mortality risk of patients with HDL-C levels of ≥50 mg/dL was 30% higher than ≤35 mg/dL, regardless the age and the total follow up. The survival rate at 6 and 12 months of follow-up for patients with HDL-C levels of ≥50 mg/dL was reduced in relation to other quartiles, with higher evidence of mortality at 12 months. Conclusions: The patients with higher HDL-C levels in the year preceding an AMI presented worse prognosis than those with lower HDL-C levels after the acute event. This reinforces the paradoxical effect of HDL-C on cardiovascular risk and the results of recent intervention studies.