The association between non-HDL cholesterol and SYNTAX score in premature heart disease

Hakan Şahin 1, Ersan Oflar 1, Cennet Yıldız 1 * , İsmail Ungan 2, Veli Polat 1, İbrahim Faruk Aktürk 1
More Detail
1 Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Istanbul, Turkey
2 Department of Cardiology, Yalova State Hospital, Yalova, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 19, Issue 5, pp. 34-37. https://doi.org/10.23950/jcmk/12523
OPEN ACCESS 591 Views 507 Downloads
Download Full Text (PDF)

ABSTRACT

Aim: This study aimed to estimate the association of coronary artery disease complexity with non-HDL-C levels in premature CAD.
Background: Primary prevention has utmost importance in terms of minimizing the number of patients who had premature coronary artery disease (CAD). Non-high density lipoprotein cholesterol (non-HDL-C) contains potentially atherogenic lipoprotein fractions.
Material and methods: Coronary angiographic recordings of two hundred acute coronary syndrome patients were evaluated by two cardiologists. Clinical, demographic and lipid parameters of the patients were compared with SYNTAX score.
Results: Median age of the study group was 41 (18-45) years. One hundred eighty five (90.5%) of them were male, nineteen (9.5%) of them were female. Median SYNTAX score and ejection fraction of the patients were 17 (4.5-39) and 50 (33-68), respectively. SYNTAX score of the male patients was significantly higher compared to females [17 (4.5-39) vs 12 (8-26), p=0.048), similarly, diabetic patients had higher values of syntax score compared to non-diabetic patients [19 (10-39) vs 16 (4.5-37), p=0.005), There were no differences of SYNTAX score with respect to presence of hypertension, smoking status and family history of CAD.  There were very strong positive correlation between SYNTAX score and non-HDL-C, TC and LDL-C levels (r=0.958, r=0.946 and r=0.921, respectively, p<0.001 for all).   HgA1c levels showed positive correlation, whereas HDL-C showed negative correlation with SYNTAX score (r=0.793 and r=-0.620, respectively, p<0.001 for both).
Conclusion: non-HDL-C was a valuable tool in assessing the complexity of atherosclerotic cardiovascular disease in young patients.

CITATION

Şahin H, Oflar E, Yıldız C, Ungan İ, Polat V, Aktürk İF. The association between non-HDL cholesterol and SYNTAX score in premature heart disease. J CLIN MED KAZ. 2022;19(5):34-7. https://doi.org/10.23950/jcmk/12523

REFERENCES

  • Onat A. Tıp Dünyasının Kronik Hastalıklara Yaklaşımına Öncülük. 2017: 25. http://file.tkd.org.tr/PDFs/TEKHARF-2017.pdf
  • Hennekens CH. Increasing burden of cardiovasculer disease: current knowledge and future directions for research on risk factors. Circulation. 1998;97(11):1095-102. https://doi.org/10.1161/01.CIR.97.11.1095
  • Ridker PM, Rifai N, Cook NK, Bradwin G, Buring JE. Non-HDL cholesterol, apolipoproteins A-I and B100, standard lipid measures, lipid ratios, and CRP as risk factors for cardiovascular disease in women. JAMA. 2005; 294(3):326-33. https://doi.org/10.1001/jama.294.3.326
  • Kannel WB, Abbott RD. Incidence and prognosis of unrecognized myocardial infarction. N Engl J Med. 1984; 311: 1144-7. https://doi.org/10.1056/NEJM198411013111802
  • Fournier JA, Sánchez A. Myocardial infarction in men aged 40 years or less: a prospective clinical-angiographic study. Clin Cardiol. 1996; 19(8):631. https://doi.org/10.1002/clc.4960190809
  • Sianos G, Morel M, Kappetein A, Morice M, Colombo A, Dawkins K, et al. The SYNTAX score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention. 2005; 1:219-27.
  • Girasis C, Garg S, Raber L, Sarno G, Morel MA, Garcia-Garcia HM, et al. SYNTAX score and clinical syntaxscore as predictors of very long-term clinical outcomes in patients undergoing percutaneous coronary interventions: a substudy of SIRolimus-eluting stent compared with pacliTAXel-eluting stent for coronary revascularization (SIRTAX) trial. Eur Heart J. 2011;32: 3115-27. https://doi.org/10.1093/eurheartj/ehr369
  • Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28:1-39.e14. https://doi.org/10.1016/j.echo.2014.10.003
  • Mohr FW1, Morice MC, Kappetein AP, Feldman TE, Ståhle E, Colombo A, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5- year follow-up of the randomised, clinical SYNTAX trial. Lancet. 2013; 381 (9867) :629-38.https://doi.org/10.1016/S0140-6736(13)60141-5
  • Hoit BD, Gilpin EA, Henning H, Maisel AA, Dittrich H, Carlisle J, et al. Myocardial infarction in young patients: an analysis by age subsets. Circulation. 1986; 74:712-21. https://doi.org/10.1161/01.CIR.74.4.712
  • Joshi P, Islam S, Pais P, Reddy S, Dorairaj P, Kazmi K, et al. Risk Factors for Early Myocardial Infarction in South Asians Compared With Individuals in Other Countries. JAMA. 2007;297(3):286-94. https://doi.org/10.1001/jama.297.3.286
  • Barbash GI, White HD, Modan M, Diaz R, Hampton JR, Heikkila J, et al. Acute myocardial infarction in the young--the role of smoking. The Investigators of the International Tissue Plasminogen Activator/Streptokinase Mortality Trial. Eur Heart J. 1995; 16:313-16
  • Wiesbauer F, Blessberger H, Azar D, Goliasch G, Wagner O, Gerhold L, et al. Familial-combined hyperlipidaemia in very young myocardial infarction survivors (< or =40 years of age). Eur Heart J. 2009; 30:1073-1079. https://doi.org/10.1093/eurheartj/ehp051
  • Larsen GK, Seth M, and Gurm HS. The ongoing importance of smoking as a powerful risk factor for ST-segment elevation myocardial infarction in young patients. JAMA Intern Med. 2013; 173:1261-2. https://doi.org/10.1001/jamainternmed.2013.6075
  • Shammas NW, Shammas GA, Jerin M, Sharis P. Sex differences in long-term outcomes of coronary patients treated with drug-eluting stents at a tertiary medical center. Vascular Health and Risk Management. 2014;10:563-568. https://doi.org/10.2147/VHRM.S64696
  • McManus DD, Piacentine SM, Lessard D, Gore JM, Yarzebski J, Spencer FA, et al. Thirty-Year (1975 to 2005) Trends in the Incidence Rates, Clinical Features, Treatment Practices, and Short-Term Outcomes of Patients <55 Years of Age Hospitalized With an Initial Acute Myocardial Infarction. Am J Cardiol. 2011; 108 (4);477-48. https://doi.org/10.1016/j.amjcard.2011.03.074
  • Chan CM, Chen WL, Kuo HY, Huang CC, Shen YS, Choy CS, et al. Circadian variation of acute myocardial infarction in young people. Am J Emerg Med. 2010; 30 (8);1461-5. https://doi.org/10.1016/j.ajem.2011.11.019
  • Iyengar SS, Gupta R, Ravi S, Thangam S, Alexander T, Manjunath CN, et al. Premature coronary artery disease in India: coronary artery disease in the young (CADY) registry. Indian Heart J. 2017; 69 (2): 211-6. https://doi.org/10.1016/j.ihj.2016.09.009
  • Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004; 364: pp. 937-52. https://doi.org/10.1016/S0140-6736(04)17018-9
  • Xiong Z, Zhu C, Qian X, Zhu J, Wu Z, Chen L. Predictors of clinical SYNTAX score in coronary artery disease: serum uric acid, smoking, and Framingham risk stratification. J Invasive Cardiol. 2011;23(12):501-4.
  • Weinberger I, Rotenberg Z, Fuchs J, Sagy A, Friedmann J, Agmon J. Myocardial infarction in young adults under 30 years: risk factors and clinical course. Clin Cardiol. 1987; 10: 9-15. https://doi.org/10.1002/clc.4960100104
  • Enas EA, Mohan V, Deepa M, Farooq S, Pazhoor S, Chennikkara H. The metabolic syndrome and dyslipidemia among Asian Indians: a population with high rates of diabetes and premature coronary artery disease. J Cardiometab Syndr. 2007;2 (4):267-75. https://doi.org/10.1111/j.1559-4564.2007.07392.x
  • Aggarwal A, Aggarwal S, Goel A, Sharma V, and Dwivedi S. A retrospective case-control study of modifiable risk factors and cutaneous markers in Indian patients with young coronary artery disease. JRSM Cardiovasc Dis. 2012;1(3):cvd.2012.012010. https://doi.org/10.1258/cvd.2012.012010
  • Matsis K, Holley A, Al-Sinan A, Matsis P, Larsen PD, Harding SA. Differing Clinical Characteristics Between Young and Older Patients Presenting with Myocardial Infarction. Heart Lung Circ. 2017;26(6):566-71. https://doi.org/10.1016/j.hlc.2016.09.007
  • Goliasch G, Oravec S, Blessberger H, Dostal E, Hoke M, Wojta J, et al. Relative importance of different lipid risk factors for the development of myocardial infarction at a very young age (≤ 40 years of age). Eur J Clin Invest. 2012;42(6):631-6. https://doi.org/10.1111/j.1365-2362.2011.02629.x
  • Shahid M, Sun RL, Liu Y, Bao JL, Xuang CX, Liao Y, et al. Is high high-density lipoprotein cholesterol beneficial for premature coronary heart disease? A meta-analysis. Eur J Prev Cardiol. 2016; 23(7):704-13. https://doi.org/10.1177/2047487315610662
  • St-Pierre AC, Cantin B, Dagenais GR, Mauriege P, Bernard PM, Despres JP, Lamarche B. Low-Density lipoprotein subfractions and the long-term risk of ischemic heart disease in men: 13-year 13-year follow-up data from the Québec Cardiovascular Study. Arterioscler Thromb Vasc Biol. 2005;25(3):553-9. https://doi.org/10.1161/01.ATV.0000154144.73236.f4
  • Rallidis LS, Pitsavos C, Panagiotakos DB, Sinos L, Stefanadis C, Kremastinos DT. Non-high density lipoprotein cholesterol is the best discriminator of myocardial infarction in young individuals. Atherosclerosis. 2005;179(2):305-9. https://doi.org/10.1016/j.atherosclerosis.2004.09.022