Initial Low-Density Lipoprotein Cholesterol and Inflammation Status Predicts Long-Term Mortality in Patients with Acute Coronary Syndrome in the Chinese Population
<b>Background</b>: Low-density lipoprotein cholesterol (LDL-C) is considered an important risk factor for acute coronary syndrome (ACS). Recent studies have revealed high mortality in ACS patients with low LDL-C levels. However, the association between spontaneously very low LDL-C levels...
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2025-06-01
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| author | Yanqiao Lu Yujun Sun Yutong Miao Zhitong Liu Lan Shen Ben He |
| author_facet | Yanqiao Lu Yujun Sun Yutong Miao Zhitong Liu Lan Shen Ben He |
| author_sort | Yanqiao Lu |
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| description | <b>Background</b>: Low-density lipoprotein cholesterol (LDL-C) is considered an important risk factor for acute coronary syndrome (ACS). Recent studies have revealed high mortality in ACS patients with low LDL-C levels. However, the association between spontaneously very low LDL-C levels and the prognosis in ACS remains unknown. <b>Methods</b>: A total of 1882 consecutive statin-null ACS patients were analyzed and categorized into four groups according to their on-admission LDL-C level: very low <70 mg/dL, low 70–99 mg/dL, high 100–129 mg/dL, and very high ≥130 mg/dL. In-hospital mortality and 3-year mortality were assessed. Among them, 1009 patients were further grouped according to the hs-CRP value (<2 mg/L and ≥2 mg/L). <b>Results</b>: Over one-third of the patients had an initially lower LDL-C concentration. Higher in-hospital mortality (9.7%, 4.5%, 2.7%, and 3.5%, <i>p</i> = 0.001), long-term mortality (20.8%, 13.1%, 8.0%, and 7.8%, <i>p</i> < 0.001), and lower survival rate (KM: HR = 3.15, 95% CI 1.40–7.12, <i>p</i> < 0.001; Cox: HR = 2.09, 95% CI 1.30 to 3.36) were observed in the very low LDL-C group compared with other groups. Patients in the low LDL-C high CRP subgroup had the worst prognosis compared with other subgroups (in-hospital: 7.7%, 1.2%, 0.5%, and 4.3%, <i>p</i> = 0.031; long-term: 15.5%, 1.2%, 2.6%, and 9.4%, <i>p</i> = 0.018). Lower LDL-C levels were accompanied by higher CRP levels (<i>p</i> = 0.003). The CRP–LDL-C ratio had good predictive ability on short-term and long-term outcomes (AUC: 0.630 and 0.738). <b>Conclusions</b>: Spontaneously very low LDL-C level was independently associated with poor long-term survival in patients with ACS. Lower LDL-C level was related to higher CRP level, while the CRP–LDL-C ratio may be a potential risk prediction factor. |
| format | Article |
| id | doaj-art-74998231f66f44b4897879868a858fc5 |
| institution | Kabale University |
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| publishDate | 2025-06-01 |
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| spelling | doaj-art-74998231f66f44b4897879868a858fc52025-08-20T04:00:54ZengMDPI AGBiomedicines2227-90592025-06-01137153410.3390/biomedicines13071534Initial Low-Density Lipoprotein Cholesterol and Inflammation Status Predicts Long-Term Mortality in Patients with Acute Coronary Syndrome in the Chinese PopulationYanqiao Lu0Yujun Sun1Yutong Miao2Zhitong Liu3Lan Shen4Ben He5Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, ChinaDepartment of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, ChinaDepartment of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, ChinaDepartment of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, ChinaMedical Center, Harrisburg Hospital, University of Pittsburgh, Pittsburgh, PA 17050, USADepartment of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China<b>Background</b>: Low-density lipoprotein cholesterol (LDL-C) is considered an important risk factor for acute coronary syndrome (ACS). Recent studies have revealed high mortality in ACS patients with low LDL-C levels. However, the association between spontaneously very low LDL-C levels and the prognosis in ACS remains unknown. <b>Methods</b>: A total of 1882 consecutive statin-null ACS patients were analyzed and categorized into four groups according to their on-admission LDL-C level: very low <70 mg/dL, low 70–99 mg/dL, high 100–129 mg/dL, and very high ≥130 mg/dL. In-hospital mortality and 3-year mortality were assessed. Among them, 1009 patients were further grouped according to the hs-CRP value (<2 mg/L and ≥2 mg/L). <b>Results</b>: Over one-third of the patients had an initially lower LDL-C concentration. Higher in-hospital mortality (9.7%, 4.5%, 2.7%, and 3.5%, <i>p</i> = 0.001), long-term mortality (20.8%, 13.1%, 8.0%, and 7.8%, <i>p</i> < 0.001), and lower survival rate (KM: HR = 3.15, 95% CI 1.40–7.12, <i>p</i> < 0.001; Cox: HR = 2.09, 95% CI 1.30 to 3.36) were observed in the very low LDL-C group compared with other groups. Patients in the low LDL-C high CRP subgroup had the worst prognosis compared with other subgroups (in-hospital: 7.7%, 1.2%, 0.5%, and 4.3%, <i>p</i> = 0.031; long-term: 15.5%, 1.2%, 2.6%, and 9.4%, <i>p</i> = 0.018). Lower LDL-C levels were accompanied by higher CRP levels (<i>p</i> = 0.003). The CRP–LDL-C ratio had good predictive ability on short-term and long-term outcomes (AUC: 0.630 and 0.738). <b>Conclusions</b>: Spontaneously very low LDL-C level was independently associated with poor long-term survival in patients with ACS. Lower LDL-C level was related to higher CRP level, while the CRP–LDL-C ratio may be a potential risk prediction factor.https://www.mdpi.com/2227-9059/13/7/1534acute coronary syndromehyperlipidemiaCRPrisk assessmentLDL-C |
| spellingShingle | Yanqiao Lu Yujun Sun Yutong Miao Zhitong Liu Lan Shen Ben He Initial Low-Density Lipoprotein Cholesterol and Inflammation Status Predicts Long-Term Mortality in Patients with Acute Coronary Syndrome in the Chinese Population Biomedicines acute coronary syndrome hyperlipidemia CRP risk assessment LDL-C |
| title | Initial Low-Density Lipoprotein Cholesterol and Inflammation Status Predicts Long-Term Mortality in Patients with Acute Coronary Syndrome in the Chinese Population |
| title_full | Initial Low-Density Lipoprotein Cholesterol and Inflammation Status Predicts Long-Term Mortality in Patients with Acute Coronary Syndrome in the Chinese Population |
| title_fullStr | Initial Low-Density Lipoprotein Cholesterol and Inflammation Status Predicts Long-Term Mortality in Patients with Acute Coronary Syndrome in the Chinese Population |
| title_full_unstemmed | Initial Low-Density Lipoprotein Cholesterol and Inflammation Status Predicts Long-Term Mortality in Patients with Acute Coronary Syndrome in the Chinese Population |
| title_short | Initial Low-Density Lipoprotein Cholesterol and Inflammation Status Predicts Long-Term Mortality in Patients with Acute Coronary Syndrome in the Chinese Population |
| title_sort | initial low density lipoprotein cholesterol and inflammation status predicts long term mortality in patients with acute coronary syndrome in the chinese population |
| topic | acute coronary syndrome hyperlipidemia CRP risk assessment LDL-C |
| url | https://www.mdpi.com/2227-9059/13/7/1534 |
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