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Low high‐density lipoprotein cholesterol predicts cardiovascular events after carotid stenting: a long‐term survey
Author(s) -
NIESSNER A.,
HOFMANN R.,
KYPTA A.,
STEINWENDER C.,
KERSCHNER K.,
KAMMLER J.,
LEISCH F.,
HUBER K.
Publication year - 2007
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/j.1538-7836.2007.02451.x
Subject(s) - medicine , interquartile range , hazard ratio , cholesterol , cardiology , myocardial infarction , confidence interval , proportional hazards model , risk factor , gastroenterology , fibrinogen , stroke (engine) , odds ratio , mechanical engineering , engineering
Summary. Background: Apart from advanced age, little is known about predictors of the long‐term outcome after carotid artery stenting (CAS). Objective: We sought to determine whether atherosclerotic risk factors predict the long‐term outcome after CAS. Patients and methods: We enrolled 532 patients assigned for CAS. The primary composite end‐point, including stroke, myocardial infarction and all‐cause mortality, was observed in 100 patients (19%) during the long‐term follow‐up (median 28 months, interquartile range 14–49 months). Results: Cumulative event rates at 1, 3 and 5 years were 4.4%, 17.1% and 33.4%, respectively. High‐density lipoprotein (HDL) cholesterol was an independent predictor of event‐free survival. The adjusted hazard ratio for the primary end‐point was 0.97 per increase of 1 mg dL −1 HDL cholesterol [95% confidence interval (CI) 0.95–0.99, P = 0.002) and 2.7 (95% CI 1.6–4.4, P < 0.001) for low HDL cholesterol (< 40 mg dL −1 in men and < 50 mg dL −1 in women). Inflammatory activation (leukocyte count > 10 000 mL −1 or fibrinogen > 450 mg dL −1 or erythrocyte sedimentation rate > 20 mm h −1 ) was the only other independent atherosclerotic risk factor ( P = 0.001). Patients with low HDL cholesterol and elevated inflammatory activation were at very high risk, with a 5‐year event rate of 59.4% (95% CI 43.6–75.2%) as compared to 15.1% (95% CI 8.2–22.0%) in those without both risk factors (log rank, P < 0.001). Age, occlusion of the contralateral carotid artery and heart failure were further independent risk predictors ( P < 0.01 for all). Conclusions: Low HDL cholesterol is an independent predictor of the long‐term outcome after CAS. The combination of low HDL cholesterol and elevated inflammatory markers identified high‐risk patients.