High density lipoprotein cholesterol in coronary artery disease: When higher means later

Aim: although high-density lipoprotein cholesterol (hdl-c) levels are inversely associated with cardiovascular risk,patients with elevated hdl-c also develop coronary artery disease (cad) and cardiac events. we aimed to draw the clinical profile of cad patients with elevated hdl-c and to assess the prognostic impact of elevated hdl-c. methods: we prospectively examined 2322 patients (age 67±10 years,79% male) with chronic cad,defined by >50% coronary stenosis and/or previous myocardial infarction. results: hdl-c levels were low (<35 mg/dl) in 736 patients (32%),normal (35-60 mg/dl) in 1464 (63%),and high (>60 mg/dl) in 122 (5%). patients with elevated hdl-c were less frequently male (p<0.0001),smokers (p<0.0001),diabetic (p<0.0001),and obese (p<0.0015) than those with low or normal hdl-c,but were 3 and 5 years older,respectively (p<0.0001). during follow-up (median,46 months) 143 patients died from cardiac causes and 80 developed a non-fatal infarction. cardiac event-free survival was lower in patients with low compared to normal hdl-c (p <0.0001),but was not significantly different from that of patients with elevated hdl-c. the prognostic impact of low hdl-c was independent of age,sex,diabetes,lv function,extent of coronary stenoses,low density lipoprotein cholesterol,triglycerides,complete blood count,thyroid and renal function (p<0.0001). conversely,the prognostic impact of elevated hdl-c disappeared (p>0.10) after adjustment for age. conclusion: patients with elevated hdl-c develop cad and cardiac events as do those with low or normal hdl,but at a more advanced age.