Abstract：
BACKGROUND: High density lipoprotein cholesterol (HDL-C) is considered as \"good cholesterol\". Recent evidence suggests that a high HDL-C level may increase the risk of poor outcomes in some populations.
OBJECTIVE: To investigate the association between HDL-C levels and poor outcomes in patients after percutaneous coronary intervention (PCI).
METHODS: Patients undergoing PCI during January 2012 and December 2018 were consecutively recruited and divided into three groups with different HDL-C levels: HDL-C ≤ 25 mg/dL, 25 < HDL-C ≤ 60 mg/dL, HDL-C > 60 mg/dL by the restricted cubic spline (RCS) analysis and assessed for all-cause mortality (ACM). The association between HDL-C levels and poor outcomes was assessed by multivariable cox regression analysis.
RESULTS: The patients were followed with a median duration of 4 years. Of the 7284 participants, 727 all-cause deaths and 334 cardiovascular deaths occurred. A V-shaped association of HDL-C with the prognosis was observed, patients with either excessively low or high HDL-C levels reporting a higher risk than those with midrange values. After adjustment for confounding factors, the former exhibited a higher cumulative rate of ACM and cardiovascular mortality (CM) than the latter [low HDL-C: for ACM, hazard ratio (HR), 1.96; 95%CI, 1.41, 2.73, P < 0.001; for CM, HR, 1.66; 95%CI, 1.03, 2.67; P = 0.037; high HDL-C: for ACM, HR, 1.73; 95%CI, 1.29, 2.32, P < 0.001; for CM, HR, 1.73; 95%CI, 1.16, 2.58; P = 0.007].
CONCLUSIONS: HDL-C levels display a V-shaped association with poor outcomes in patients after PCI, with excessively high or low HDL-C suggesting a higher mortality risk. An optimal HDL-C level may fall in the range of 25-60 mg/dL.
OBJECTIVE: To investigate the association between HDL-C levels and poor outcomes in patients after percutaneous coronary intervention (PCI).
METHODS: Patients undergoing PCI during January 2012 and December 2018 were consecutively recruited and divided into three groups with different HDL-C levels: HDL-C ≤ 25 mg/dL, 25 < HDL-C ≤ 60 mg/dL, HDL-C > 60 mg/dL by the restricted cubic spline (RCS) analysis and assessed for all-cause mortality (ACM). The association between HDL-C levels and poor outcomes was assessed by multivariable cox regression analysis.
RESULTS: The patients were followed with a median duration of 4 years. Of the 7284 participants, 727 all-cause deaths and 334 cardiovascular deaths occurred. A V-shaped association of HDL-C with the prognosis was observed, patients with either excessively low or high HDL-C levels reporting a higher risk than those with midrange values. After adjustment for confounding factors, the former exhibited a higher cumulative rate of ACM and cardiovascular mortality (CM) than the latter [low HDL-C: for ACM, hazard ratio (HR), 1.96; 95%CI, 1.41, 2.73, P < 0.001; for CM, HR, 1.66; 95%CI, 1.03, 2.67; P = 0.037; high HDL-C: for ACM, HR, 1.73; 95%CI, 1.29, 2.32, P < 0.001; for CM, HR, 1.73; 95%CI, 1.16, 2.58; P = 0.007].
CONCLUSIONS: HDL-C levels display a V-shaped association with poor outcomes in patients after PCI, with excessively high or low HDL-C suggesting a higher mortality risk. An optimal HDL-C level may fall in the range of 25-60 mg/dL.
摘要：
背景：高密度脂蛋白胆固醇（HDLC）被认为是“好胆固醇”。最近的证据表明，高HDL-C水平可能会增加某些人群不良结局的风险。
目的：探讨HDL-C水平与经皮冠状动脉介入治疗（PCI）术后不良预后的关系。
方法：连续招募2012年1月和2018年12月接受PCI的患者，并分为三组，HDL-C水平不同：HDL-C≤25mg/dL，2560mg/dL，通过限制性三次样条（RCS）分析，并评估全因死亡率（ACM）。通过多变量cox回归分析评估HDL-C水平与不良预后之间的关联。
结果：对患者进行随访，中位随访时间为4年。在7284名参与者中，发生了727例全因死亡和334例心血管死亡。观察到HDL-C与预后的V形关联，HDL-C水平过低或过高的患者报告的风险高于中值患者.在对混杂因素进行调整后，前者表现出比后者更高的ACM和心血管死亡率（CM）的累积率[低HDLC：对于ACM，危险比(HR)，1.96；95CI，1.41，2.73，P<0.001；对于CM，HR,1.66；95CI，1.03，2.67；P=0.037；高HDLC：对于ACM，HR,1.73；95CI，1.29，2.32，P<0.001；对于CM，HR,1.73；95CI，1.16，2.58；P=0.007]。
结论：HDL-C水平与PCI术后患者的不良预后呈V型关系，HDL-C过高或过低提示死亡风险较高。最佳HDL-C水平可以落在25-60mg/dL的范围内。
目的：探讨HDL-C水平与经皮冠状动脉介入治疗（PCI）术后不良预后的关系。
方法：连续招募2012年1月和2018年12月接受PCI的患者，并分为三组，HDL-C水平不同：HDL-C≤25mg/dL，25
结果：对患者进行随访，中位随访时间为4年。在7284名参与者中，发生了727例全因死亡和334例心血管死亡。观察到HDL-C与预后的V形关联，HDL-C水平过低或过高的患者报告的风险高于中值患者.在对混杂因素进行调整后，前者表现出比后者更高的ACM和心血管死亡率（CM）的累积率[低HDLC：对于ACM，危险比(HR)，1.96；95CI，1.41，2.73，P<0.001；对于CM，HR,1.66；95CI，1.03，2.67；P=0.037；高HDLC：对于ACM，HR,1.73；95CI，1.29，2.32，P<0.001；对于CM，HR,1.73；95CI，1.16，2.58；P=0.007]。
结论：HDL-C水平与PCI术后患者的不良预后呈V型关系，HDL-C过高或过低提示死亡风险较高。最佳HDL-C水平可以落在25-60mg/dL的范围内。
