HDL cholesterol level predicts survival in men after coronary artery bypass graft surgery - 20-year experience from the Cleveland Clinic Foundation

Background-HDL cholesterol (HDL-C) is an important independent predictor of atherosclerosis, yet the role that HDL-C may play in the prediction of lon g-term survival after CABG remains unclear, The risk associated with a low HDL-C level in post-CABG men has not been delineated in relation to traditi onal surgical variables such as the use of arterial conduits, left ventricu lar function, and extent of disease. Methods and Results-We performed a prospective, observational study of 432 men who underwent CABG between 1978 and 1979 in whom preoperative HDL-C val ues were available. Baseline lipid and lipoprotein values, history of diabe tes mellitus and hypertension, left ventricular ejection fraction, extent o f disease, and use of internal thoracic arteries were recorded. Hazard rati os (HRs) were determined in the patients with and without a low HDL-C level , which was defined as the lowest HDL-C quartile (HDL-C less than or equal to 35 mg/dL), After adjustment for age, as well as for baseline metabolic p arameters and surgical variables just noted, HDL-C corresponded to both ove rall (HR 0.40, CI 0.20 to 0.83, P=0.01) and event-foe (HR 0.41, CI 0.24 to 0.70, P=0.001) survival. Patients with a high HDL-C level (>35 mg/dL) were 50% more likely to survive at 15 years than were patients with low HDL-C le vel (less than or equal to 35 mg/dL) (74% versus 57% adjusted survival, res pectively; HR 1.72, P=0.005). In addition, HDL-C showed a strong effect on time-to-event survival such that patients with an HDL-C level of >35 mg/dL were 50% more likely to survive without a subsequent myocardial infarction or revascularization (HR 1.42, P=0.02). Conclusions-HDL-C is an important predictor of survival in post-CABG patien ts. In this study of >8500 patient-years of follow-up, HDL-C was the most i mportant metabolic predictor of post-CABG survival, One third fewer patient s survive at 15 years if their HDL-C levels are less than or equal to 35 mg /dL at the time of CABG, The measurement of HDL-C provides a compelling str ategy for the identification of high-risk subsets of patients who undergo C ABG.