Association between hyperlipidemia and mortality after incident acute myocardial infarction or acute decompensated heart failure: a propensity score matched cohort study and a meta-analysis
Objective To examine the effect of HLP, defined as having a pre-existing or a new in-hospital diagnosis based on low density lipoprotein cholesterol (LDL-C) level ≥100 mg/dL during index hospitalisation or within the preceding 6 months, on all-cause mortality after hospitalisation for acute myocardi...
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BMJ Publishing Group
2019-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/12/e028638.full |
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| author | Zhen Wang M Hassan Murad Mohammed Yousufuddin Umesh Sharma Paul Y Takahashi Brittny Major Eimad Ahmmad Hossam Al-Zubi Jessica Peters Taylor Doyle Kelsey Jensen Ruaa Y Al Ward Ashok Seshadri Vinaya Simha |
| author_facet | Zhen Wang M Hassan Murad Mohammed Yousufuddin Umesh Sharma Paul Y Takahashi Brittny Major Eimad Ahmmad Hossam Al-Zubi Jessica Peters Taylor Doyle Kelsey Jensen Ruaa Y Al Ward Ashok Seshadri Vinaya Simha |
| author_sort | Zhen Wang |
| collection | DOAJ |
| description | Objective To examine the effect of HLP, defined as having a pre-existing or a new in-hospital diagnosis based on low density lipoprotein cholesterol (LDL-C) level ≥100 mg/dL during index hospitalisation or within the preceding 6 months, on all-cause mortality after hospitalisation for acute myocardial infarction (AMI) or acute decompensated heart failure (ADHF) and to determine whether HLP modifies mortality associations of other competing comorbidities. A systematic review and meta-analysis to place the current findings in the context of published literature.Design Retrospective study, 1:1 propensity-score matching cohorts; a meta-analysis.Setting Large academic centre, 1996–2015.Participants Hospitalised patients with AMI or ADHF.Main outcomes and measures All-cause mortality and meta-analysis of relative risks (RR).Results Unmatched cohorts: 13 680 patients with AMI (age (mean) 68.5 ± (SD) 13.7 years; 7894 (58%) with HLP) and 9717 patients with ADHF (age, 73.1±13.7 years; 3668 (38%) with HLP). In matched cohorts, the mortality was lower in AMI patients (n=4348 pairs) with HLP versus no HLP, 5.9 versus 8.6/100 person-years of follow-up, respectively (HR 0.76, 95% CI 0.72 to 0.80). A similar mortality reduction occurred in matched ADHF patients (n=2879 pairs) with or without HLP (12.4 vs 16.3 deaths/100 person-years; HR 0.80, 95% CI 0.75 to 0.86). HRs showed modest reductions when HLP occurred concurrently with other comorbidities. Meta-analyses of nine observational studies showed that HLP was associated with a lower mortality at ≥2 years after incident AMI or ADHF (AMI: RR 0.72, 95% CI 0.69 to 0.76; heart failure (HF): RR 0.67, 95% CI 0.55 to 0.81).Conclusions Among matched AMI and ADHF cohorts, concurrent HLP, compared with no HLP, was associated with a lower mortality and attenuation of mortality associations with other competing comorbidities. These findings were supported by a systematic review and meta-analysis. |
| format | Article |
| id | doaj-art-da8a0f234bbf4d0580743a24ad31af23 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-da8a0f234bbf4d0580743a24ad31af232025-08-20T02:38:51ZengBMJ Publishing GroupBMJ Open2044-60552019-12-0191210.1136/bmjopen-2018-028638Association between hyperlipidemia and mortality after incident acute myocardial infarction or acute decompensated heart failure: a propensity score matched cohort study and a meta-analysisZhen Wang0M Hassan Murad1Mohammed Yousufuddin2Umesh Sharma3Paul Y Takahashi4Brittny Major5Eimad Ahmmad6Hossam Al-Zubi7Jessica Peters8Taylor Doyle9Kelsey Jensen10Ruaa Y Al Ward11Ashok Seshadri12Vinaya Simha13Health Care Policy and Research, Mayo Clinic Minnesota, Rochester, Minnesota, USARobert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USAHospital Internal Medicine, Mayo Clinic Minnesota, Austin, Minnesota, USA2 Internal Medicine, Mayo Clinic Health System in Albert Lea, Albert Lea, Minnesota, USADivision of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA1 Internal Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USA2 Internal Medicine, Mayo Clinic Health System in Albert Lea, Albert Lea, Minnesota, USA2 Internal Medicine, Mayo Clinic Health System in Albert Lea, Albert Lea, Minnesota, USA1 Internal Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USA1 Internal Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USAPharmacy, Mayo Clinic Health System Austin, Austin, Minnesota, USA1 Internal Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USA1 Internal Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USA1 Internal Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USAObjective To examine the effect of HLP, defined as having a pre-existing or a new in-hospital diagnosis based on low density lipoprotein cholesterol (LDL-C) level ≥100 mg/dL during index hospitalisation or within the preceding 6 months, on all-cause mortality after hospitalisation for acute myocardial infarction (AMI) or acute decompensated heart failure (ADHF) and to determine whether HLP modifies mortality associations of other competing comorbidities. A systematic review and meta-analysis to place the current findings in the context of published literature.Design Retrospective study, 1:1 propensity-score matching cohorts; a meta-analysis.Setting Large academic centre, 1996–2015.Participants Hospitalised patients with AMI or ADHF.Main outcomes and measures All-cause mortality and meta-analysis of relative risks (RR).Results Unmatched cohorts: 13 680 patients with AMI (age (mean) 68.5 ± (SD) 13.7 years; 7894 (58%) with HLP) and 9717 patients with ADHF (age, 73.1±13.7 years; 3668 (38%) with HLP). In matched cohorts, the mortality was lower in AMI patients (n=4348 pairs) with HLP versus no HLP, 5.9 versus 8.6/100 person-years of follow-up, respectively (HR 0.76, 95% CI 0.72 to 0.80). A similar mortality reduction occurred in matched ADHF patients (n=2879 pairs) with or without HLP (12.4 vs 16.3 deaths/100 person-years; HR 0.80, 95% CI 0.75 to 0.86). HRs showed modest reductions when HLP occurred concurrently with other comorbidities. Meta-analyses of nine observational studies showed that HLP was associated with a lower mortality at ≥2 years after incident AMI or ADHF (AMI: RR 0.72, 95% CI 0.69 to 0.76; heart failure (HF): RR 0.67, 95% CI 0.55 to 0.81).Conclusions Among matched AMI and ADHF cohorts, concurrent HLP, compared with no HLP, was associated with a lower mortality and attenuation of mortality associations with other competing comorbidities. These findings were supported by a systematic review and meta-analysis.https://bmjopen.bmj.com/content/9/12/e028638.full |
| spellingShingle | Zhen Wang M Hassan Murad Mohammed Yousufuddin Umesh Sharma Paul Y Takahashi Brittny Major Eimad Ahmmad Hossam Al-Zubi Jessica Peters Taylor Doyle Kelsey Jensen Ruaa Y Al Ward Ashok Seshadri Vinaya Simha Association between hyperlipidemia and mortality after incident acute myocardial infarction or acute decompensated heart failure: a propensity score matched cohort study and a meta-analysis BMJ Open |
| title | Association between hyperlipidemia and mortality after incident acute myocardial infarction or acute decompensated heart failure: a propensity score matched cohort study and a meta-analysis |
| title_full | Association between hyperlipidemia and mortality after incident acute myocardial infarction or acute decompensated heart failure: a propensity score matched cohort study and a meta-analysis |
| title_fullStr | Association between hyperlipidemia and mortality after incident acute myocardial infarction or acute decompensated heart failure: a propensity score matched cohort study and a meta-analysis |
| title_full_unstemmed | Association between hyperlipidemia and mortality after incident acute myocardial infarction or acute decompensated heart failure: a propensity score matched cohort study and a meta-analysis |
| title_short | Association between hyperlipidemia and mortality after incident acute myocardial infarction or acute decompensated heart failure: a propensity score matched cohort study and a meta-analysis |
| title_sort | association between hyperlipidemia and mortality after incident acute myocardial infarction or acute decompensated heart failure a propensity score matched cohort study and a meta analysis |
| url | https://bmjopen.bmj.com/content/9/12/e028638.full |
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