SESSION TITLE: Pulmonary Hypertension (Poster Discussion)
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM
PURPOSE: Pulmonary arterial hypertension (PAH) is characterized by derangements in the endothelin, nitric oxide, and prostacyclin pathways which are associated with pulmonary vascular remodeling, elevated pulmonary artery pressures, and right ventricular failure. Long term survival remains poor despite advances in targeted medical therapy. Additional markers are needed to identify patients at high risk for adverse outcomes who may benefit from more aggressive therapy early in the course of their disease. High-density lipoprotein (HDL) cholesterol has both vasodilatory and anti-inflammatory properties and has been proposed as one such marker. Higher levels of HDL cholesterol may be associated with improved survival in PAH, however, the current data in the literature is conflicting.
METHODS: A retrospective chart review of adult patients diagnosed with PAH at Mayo Clinic Rochester from January 1, 1995 to December 31, 2010 was performed to identify patients who had an HDL cholesterol checked within 3 months prior to or 1 month after diagnosis with PAH. Survival was analyzed using the Kaplan Meier method. Univariate and multivariate Cox proportional hazards ratios were calculated to evaluate the association between baseline HDL level and survival.
RESULTS: HDL cholesterol levels were available for 229 patients with idiopathic, connective tissue disease associated or portopulmonary PAH. Patients were divided into 3 groups by HDL cholesterol level (group 1 HDL <34, group 2 HDL 34-55, group 3 HDL >55). Higher HDL cholesterol levels were associated with significantly lower mortality overall and in patients with idiopathic and connective tissue disease associated PAH. Patients with an HDL cholesterol >55 at diagnosis had a 5 yr survival of 65% compared with 30% for those with an HDL cholesterol <34 at diagnosis. On univariate analysis, higher HDL cholesterol levels were associated with a risk ratio for death of 0.75 (CI 0.64-0.86; p <0.0001). On multivariate analysis, higher HDL cholesterol levels were associated with a risk ratio for death of 0.81 (CI 0.70-0.94; p=0.0045) after adjusting for etiology of PAH, 6 minute walk distance, DLCO, estimated GFR, and severe right ventricular enlargement.
CONCLUSIONS: HDL cholesterol level assessed at the time of diagnosis is a significant predictor of survival in PAH by univariate and multivariate analysis.
CLINICAL IMPLICATIONS: HDL cholesterol is an inexpensive and readily available marker that may prove useful when estimating long term outcomes in PAH.
DISCLOSURE: Robert Frantz: Consultant fee, speaker bureau, advisory committee, etc.: United Therapeutics: Steering Committee, Research Support, and Advisory Board, Consultant fee, speaker bureau, advisory committee, etc.: Actelion: Steering Committee and Advisory Board The following authors have nothing to disclose: Carolyn Larsen, Garvan Kane
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