High HDL‐Cholesterol Levels Are Associated With Lower Risk of Acute Coronary Syndromes in Coronary Artery Disease

Background: The inverse association between HDL‐cholesterol (HDL‐C) levels and the risk of cardiovascular diseases is evident. Hypothesis: Our hypothesis was that higher levels of HDL‐C predisposed patients with coronary artery disease (CAD) to chronic coronary syndromes (CCS) rather than acute coronary syndrome (ACS), which has not clearly been demonstrated yet. Aim: To determine, in an unselected population of patients treated with percutaneous coronary intervention (PCI), if HDL‐C levels are independently higher in subjects presenting with CCS compared with those with ACS. Methods and Results: In this retrospective study, we identified 4215 patients who underwent PCI in the Cardio‐FR database. A total of 2942 patients met the selection criteria and completed at least a 1‐year follow‐up: 1686 suffered an ACS whereas 1256 presented with CCS. We found that low HDL‐C levels were significantly associated with ACS and high HDL‐C levels with CCS. This was consistent across all BMI categories in both genders. In addition, higher HDL‐C levels reduced the likelihood of CAD subjects developing ACS. Specifically, each mmol/L increase in HDL‐C decreased the odds of ACS by 79%. Interestingly, the CCS group had more polymorbid subjects than the ACS group. At 2‐year follow‐up, no difference in patient‐oriented composite endpoint was seen between high and low HDL‐C groups. Conclusion: In an unselected population of coronary patients, HDL‐C levels were consistently lower in individuals presenting with ACS compared with CCS, independently of BMI and gender. This finding strengthens the hypothesis that HDL‐C plays a role in long‐term protection against atherosclerotic plaque vulnerability. Considering HDL‐C level still makes sense. Trial Registration: ClinicalTrials.gov identifier: NCT04185285