The effects of dyslipidemia on left ventricular systolic function in patients with stable angina pectoris

Large-scale clinical trials have shown that long-term treatment with lipid- lowering therapy results in a significant reduction in the occurrence of he art failure among patients with coronary artery disease without previous ev idence of congestive heart failure, suggesting dyslipidemia may have an adv erse effect on left ventricular performance. To examine whether dyslipidemi a has a detrimental effect on left ventricular systolic function and whethe r this effect is dependent on the corresponding severity of coronary athero sclerosis, 114 consecutive patients with stable angina and a positive exerc ise thallium-201 myocardial perfusion single-photon emission computed tomog raphy were studied. All patients underwent measurement of serum lipid profi les, right-sided heart catheterization, left ventriculography, and selectiv e coronary arteriography, Mean serum levels of total cholesterol and trigly cerides were 4.5 and 1.4 mmol/l, respectively. In univariate analysis, a si gnificant positive correlation between serum high-density lipoprotein (HDL) cholesterol and left ventricular ejection fraction (LVEF) (r = 0.49, P < 0 .0001) was found. Patients in the lower tertile of serum HDL cholesterol ha d a significantly lower mean LVEF than those in the upper tertile (55.9 +/- 15.2 vs. 72.8 +/- 6.8%, P < 0.0001), Stepwise multiple linear regression a nalysis revealed that LVEF significantly correlated with HDL cholesterol (P < 0.0001), the Gensini score (P = 0.008), and diabetes mellitus (P = 0.08) (r = 0.55, P < 0.0001). In subgroup analysis of patients with angiographic ally normal coronary arteries, serum HDL cholesterol was still significantl y associated with LVEF. The present study demonstrated an independent assoc iation between low HDL cholesterol and Subclinical left ventricular systoli c dysfunction in Chinese patients with stable angina whose serum levels of total cholesterol and triglycerides were relatively low. Moreover, this cor relation remained significant even in patients with normal coronary angiogr ams, suggesting HDL cholesterol might influence left ventricular systolic p erformance through extra-atherosclerotic mechanisms. (C) 1999 Elsevier Scie nce Ireland Ltd, Ail rights reserved.