Plasma Lipids during Acute Coronary Syndrome: Association to Malignancy Mortality after 17 Years of Follow-Up: The ABC-4 Study on Acute Coronary Syndrome

Purpose: Our aim was to investigate the association between plasma lipids [total cholesterol (TC), HDL-C LDL-C, and tryglycerides (TG)] in patients discharged alive after acute coronary syndrome (ACS) and mortality due to malignant neoplasia after 17 years of follow up.
Methods: The ABC 4-Study on Acute Coronary Syndrome is an ongoing, prospective investigation designed to reflect, as closely as possible, an unbiased population of patients with ACS. The present study includes 634 patients enrolled in three intensive coronary care units.
Results: Mean±SD age was 66±12 years, female=29%, hypertensives=47%, diabetics=22%, all smokers=67%, NSTEMI=38%. Killip class>1=33%, use of statins during index hospitalization=15%. Mean±SD values of plasma lipids levels were: CT=212±49 mg/dl, HDL=45±12, cLDL (calculated according to modified Friedwald formula)=134±40, TG=154±103. Deaths due to malignancies were in 15% of the patients. Both At Cox univariable level TC levels showed an inverse association with all-cause mortality, Z=-3.99, p<0.0001; HDL, Z=-0.34, p=0.73; cLDL, Z=-3.61, p<0.0001; TG, Z=-2.44, p=0.01. At multivariable level (models included the 8 clinical variables above mentioned plus lipid value), TC levels showed an inverse independent association with neoplastic mortality, Z=-2.97, p=0.003; HDL, Z=-1.15, p=0.25; cLDL, Z=-2.66, p=0.008; TG, Z=-1.04, p=0.29. The other clinical variables independently associated to mortality were: age, and smoking habit.
Conclusion: We observed an independent negative association between TC, HDL, cLDL plasma levels during ACS and mortality associated to malignancies, through 17 years of follow up. We believe that the uncommon long-term follow up of the patients in the present study, may contribute to understand the results.