Tools
Tools
Sia, Ching-Hui, Zheng, Huili, Ho, Andrew Fu-Wah, Bulluck, Heerajnarain 
ORCID: https://orcid.org/0000-0002-1985-1783, Chong, Jun, Foo, David, Foo, Ling-Li, Lim, Patrick Zhan Yun, Liew, Boon Wah, Tan, Huay-Cheem, Yeo, Tiong-Cheng, Chua, Terrance Siang Jin, Chan, Mark Yan-Yee and Hausenloy, Derek J
(2020)
The lipid paradox is present in ST-elevation but not in non-ST-elevation myocardial infarction patients: Insights from the Singapore Myocardial Infarction Registry.
Scientific Reports, 10.
ISSN 2045-2322
Preview |
PDF (Published_Version)
- Published Version
Available under License Creative Commons Attribution. Download (1MB) | Preview |
Abstract
Lowering low-density lipoprotein (LDL-C) and triglyceride (TG) levels form the cornerstone approach of cardiovascular risk reduction, and a higher high-density lipoprotein (HDL-C) is thought to be protective. However, in acute myocardial infarction (AMI) patients, higher admission LDL-C and TG levels have been shown to be associated with better clinical outcomes - termed the 'lipid paradox'. We studied the relationship between lipid profile obtained within 72 hours of presentation, and all-cause mortality (during hospitalization, at 30-days and 12-months), and rehospitalization for heart failure and non-fatal AMI at 12-months in ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients treated by percutaneous coronary intervention (PCI). We included 11543 STEMI and 8470 NSTEMI patients who underwent PCI in the Singapore Myocardial Infarction Registry between 2008-2015. NSTEMI patients were older (60.3 years vs 57.7 years, p < 0.001) and more likely to be female (22.4% vs 15.0%, p < 0.001). In NSTEMI, a lower LDL-C was paradoxically associated with worse outcomes for death during hospitalization, within 30-days and within 12-months (all p < 0.001), but adjustment eliminated this paradox. In contrast, the paradox for LDL-C persisted for all primary outcomes after adjustment in STEMI. For NSTEMI patients, a lower HDL-C was associated with a higher risk of death during hospitalization but in STEMI patients a lower HDL-C was paradoxically associated with a lower risk of death during hospitalization. For this endpoint, the interaction term for HDL-C and type of MI was significant even after adjustment. An elevated TG level was not protective after adjustment. These observations may be due to differing characteristics and underlying pathophysiological mechanisms in NSTEMI and STEMI.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | aged,blood,female,statistics & numerical data,humans,male,middle aged,blood,methods,methods,statistics & numerical data,retrospective studies,risk factors,blood,singapore,time factors,blood |
| Faculty \ School: | |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 21 Apr 2021 23:49 |
| Last Modified: | 31 Jan 2024 03:00 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/79848 |
| DOI: | 10.1038/s41598-020-63825-8 |
Downloads
Downloads per month over past year
Actions (login required)
 |
View Item |