Clinical significance of low HDL-C levels in managing acute coronary syndrome.

Abstract

Objective: To investigate the clinical relevance of low HDL-C levels in the management of ACS, focusing on their association with adverse outcomes. Study Design: Prospective Observational study. Setting: Faisalabad Institute of Cardiology, Faisalabad. Period: December 2021 to May 2022. Methods: 384 patients diagnosed with ACS, admitted to a tertiary care hospital in Pakistan. HDL-C levels were measured within 24 hours of admission, and participants were stratified into low HDL-C (<40 mg/dL) and normal HDL-C (≥40 mg/dL) groups. Adverse outcomes, including 30-day mortality, recurrent myocardial infarction, heart failure, and hospital stay duration, were analyzed using multivariate logistic regression and Kaplan-Meier survival analysis. Statistical significance was set at p < 0.05. Results: Low HDL-C levels were observed in 210 patients (54.7%). These patients experienced significantly higher rates of 30-day mortality (21.4% vs. 6.9%), recurrent myocardial infarction (24.8% vs. 8.6%), and heart failure (31.9% vs. 13.2%) compared to those with normal HDL-C levels (p < 0.001 for all). Kaplan-Meier survival analysis showed reduced survival rates at 30 days (78.6% vs. 93.1%) and 90 days (65.2% vs. 88.7%) in the low HDL-C group (p < 0.001). Multivariate analysis identified low HDL-C as the strongest independent predictor of adverse outcomes (OR 2.85, 95% CI: 1.85–4.39, p < 0.001). Conclusion: Low HDL-C levels are a significant independent predictor of adverse outcomes in ACS patients, highlighting their importance in risk stratification and management. These findings emphasize the need for targeted therapeutic strategies to address low HDL-C levels, particularly in resource-limited settings.