Protective effect of high-density lipoprotein in infective endocarditis patients after valve surgery

Abstract

Introduction: Lipoproteins and insulin resistance are associated with the prognosis of cardiovascular disease, with strong evidence supporting a causal relationship for some; however, whether lipoproteins and insulin resistance have prognostic value in patients with infective endocarditis after valve surgery remains unclear.

Methods: We included 278 consecutive patients with a definite diagnosis of IE who underwent valve surgery from January 2010 to December 2022. Mortality was analyzed in relation to lipid profile and insulin resistance. Patients were divided into a higher high-density lipoprotein (＞0.905 mmol/L) group and a lower high-density lipoprotein (≤0.905 mmol/L) group based on the cutoff value of the high-density lipoprotein. A Kaplan-Meier survival analysis was conducted for patients in two groups. Subgroup analysis and restricted cubic splines regression of the association between baseline high-density lipoprotein and incident all-cause mortality were performed.

Results: Among 278 patients (mean age 44.96 years, 28.1 % female), there were 36 all-cause mortalities during a median 60.98 months follow-up. Kaplan-Meier survival analysis showed lower 12-year mortality in patients with high-density lipoprotein levels > 0.905 mmol/L (HR = 0.125, p < 0.001). There were no significant interactions in any of the subgroups. The adverse effect of high-density lipoprotein on all-cause mortality was consistent after adjusting for the confounders across all subgroups. The restricted cubic splines regression model revealed a linear association between high-density lipoprotein and the risk of all-cause mortality (p for nonlinearity = 0.477), and this linear association is more pronounced in women.

Conclusion: High-density lipoprotein levels are associated with lower mortality in infective endocarditis patients after valve surgery, particularly in female patients.

Keywords: High-density lipoprotein; Infective endocarditis; Mortality; Valve surgery.

Fig. 1

Flow chart for selecting IE patients who underwent valve surgery for analysis.

Fig. 2

The Kaplan–Meier survival curves of patients after valve surgery with higher HDL-C versus lower HDL-C. HR (95 % CI) = 0.152 (0.054–0.430)；Log rank p＜0.001.

Fig. 3

Subgroup analysis of the association between baseline HDL-C and incident all-cause mortality. HR, hazard ratios; CI, confidence interval.

Fig. 4

Adjusted hazard ratios for incident all-cause mortality by baseline HDL-c. The black dotted line represents HR = 1. The solid line shows the HR value. The blue and red shaded area represents the 95 % CI. HR, hazard ratios; CI, confidence interval. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)