Non-HDL Cholesterol, Inflammation Appear to Be Linked in Patients Undergoing Elective PCI

INNSBRUCK, Austria—Among elective PCI patients, an increased postprocedural inflammatory response is linked with higher preprocedural levels of non-HDL cholesterol—a catchall term that encompasses LDL cholesterol as well as other atherogenic lipoproteins—regardless of statin use and extent of myocardial injury, according to a single-center study.

The results hint that controlling non-HDL cholesterol as a whole rather than focusing only on the oft-used target of LDL cholesterol could lead to improved outcomes, investigator Fabiana Rached, PhD (University of São Paulo, Brazil), told TCTMD.

Inflammation has long been speculated to play a role in the development of atherosclerotic cardiovascular disease. The JUPITER trial, published in 2008, showed improved clinical outcomes associated with statin treatment over 5 years in more than 17,000 patients with high a degree of inflammation and apparently normal LDL cholesterol levels who were randomized to rosuvastatin 20 mg (Crestor; AstraZeneca), as compared with patients randomized to placebo.

In a poster at the 2016 European Atherosclerosis Society Congress, Rached highlighted non-HDL cholesterol as a potential cause of inflammation in stable patients undergoing PCI. Her team enrolled 718 patients from their institution who successfully underwent elective PCI, and classified 56.8% as having controlled or “low” preprocedural non-HDL cholesterol levels (< 100 mg/dL).

After PCI, higher levels of high-sensitivity C-reactive protein (hsCRP) were found in the blood samples of those with high compared with low preprocedural levels of non-HDL cholesterol (P = 0.009). Surprisingly, preprocedural statin use and the extent of myocardial injury were not associated with a post-PCI inflammatory response, Rached said.

Also, although the researchers measured MACE out to 5 years, there was no statistical difference between the low and high non-HDL cholesterol groups (8.6% vs 10.9%; P = 0.315). Rached said this could be due to the small sample size, but also suggested it might harken back to the overall mystery of whether inflammation is truly linked with a greater risk of adverse cardiac events.

With these findings in mind, Rached advised physicians to control non-HDL cholesterol in stable patients before PCI. “You have time to do that,” she said, adding that while most doctors do a good job of measuring and controlling LDL cholesterol, they would be better informed to also look at the broader total of non-HDL cholesterol. With statins, PCSK9 inhibitors, and ezetimibe, “we have lots of medications we can use,” she said.

Future research on stable patients and cholesterol should focus on getting a clearer picture of how inflammatory markers play into overall outcomes, Rached concluded. Ultimately, she said, “it needs a bigger trial.”