Lipid paradox in patients with acute myocardial infarction: Potential impact of malnutrition. Issue 5 (October 2019)

• Record Type: Journal Article
• Authors: Lu, Ya-Wen; Lu, Shu-Fen; Chou, Ruey-Hsing; Wu, Po-Shan; Ku, Yu-Chen; Kuo, Chin-Sung; Chang, Chun-Chin; Tsai, Yi-Lin; Wu, Cheng-Hsueh; Huang, Po-Hsun
• Is Part Of: Clinical nutrition. Volume 38:Issue 5(2019)
• Page Start: 2311
• Page End: 2318
• Publication Date: 2019-10
• Subjects: Lipid paradox -- Low-density lipoprotein -- Malnutrition -- Acute myocardial infarction; ACS acute coronary syndrome -- AMI acute myocardial infarction -- BMI body mass index -- CAD coronary artery disease -- LDL low-density lipoprotein -- eGFR estimated glomerular filtration rate -- ICU intensive care unit -- LV left ventricle -- NRI nutritional risk index -- Non-STEMI non-ST-segment elevation myocardial infarction -- STEMI ST-segment elevation myocardial infarction -- TG triglyceride -- WBC white blood cell; Critically ill -- Nutrition -- Periodicals; Diet therapy -- Periodicals; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; Enteral Nutrition -- Periodicals; Parenteral Nutrition -- Periodicals; Metabolism -- Periodicals; Diétothérapie -- Périodiques; Alimentation parentérale -- Périodiques; Alimentation entérale -- Périodiques; Nutrition -- Périodiques; Diet therapy; Enteral feeding; Nutrition; Parenteral feeding; Electronic journals; Periodicals; Electronic journals; 615.854
• DOI: 10.1016/j.clnu.2018.10.008
• Languages: English
• ISSNs: 0261-5614

Abstract

Summary: Background & aims: Aggressive lipid reduction is recommended for patients with AMI, but reverse epidemiology, the lipid paradox, has been reported in several clinical studies. The cause of lipid paradox remains uncertain, and nutrition is one possible explanation. In this single-center retrospective study, we investigated the relationships between baseline LDL concentrations and clinical outcomes in patients with AMI, stratified by different nutritional status. Methods: Totally 409 patients were enrolled for analysis. The Nutritional Risk Index (NRI) was used to estimate the risk of malnutrition. Subjects were grouped into tertiles according to their NRIs. Clinical outcomes were compared among patients with varying NRIs and LDL levels. Results: Patients in the lowest NRI tertile had increased incidences of in-hospital mortality, cardiogenic shock, decompensated heart failure, renal failure, and sepsis. This tertile was also associated with increased long-term mortality during the follow-up period of 832 ± 744 days. Mortality was increased among patients with baseline LDL concentrations ≤70 mg/dL in the lowest NRI tertile (log rank test, p = 0.0257), but not in the high or median tertiles. Moreover, baseline LDL level ≤70 mg/dL was an independent risk factor of all-cause mortality (adjusted hazard ratio = 1.73; 95% confidence interval, 1.01–2.94; p = 0.045) in the lowest NRI tertile. Conclusions: Lipid paradox was observed in the high-risk of malnutrition population among patients with AMI. Aggressive lipid-lowering therapy is still recommended for patients with AMI and fair nutritional status. However, when treating patients at high risk of malnutrition, the improvement of nutritional status may be more beneficial than strict LDL control. Highlights: Lower NRI is associated with increased mortality in patients with AMI. Lipid paradox is only observed in patients with the lowest NRI tertile. Benefit of strict LDL control is limited in patients with AMI & malnutrition.