Prevalence of low high-density lipoprotein cholesterol (HDL-C) as a marker of residual cardiovascular risk among acute coronary syndrome patients from Oman

Objective: To estimate the prevalence as well as predictors of low high-density lipoprotein cholesterol (HDL-C) levels among acute coronary syndrome (ACS) patients in Oman. Methods: Data were analyzed from the records of 1583 consecutive patients admitted with a diagnosis of ACS as part of the Gulf Registry of Acute Coronary Events (Gulf RACE). A low HDL-C was considered as <40 mg/dL for males and <50 mg/dL for females. Results: The overall mean age of the cohort was 59 ± 13 years ranging from 19 to 102 with patients being mostly male (62%) and Omani (83%). The majority were on statin therapy (84%) and 1.1% were on fenofibrate. The overall prevalence of low HDL-C for this ACS population in Oman was 53% mostly affecting females (67 vs. 43%; p < 0.001). After covariate adjustment, renal impairment (serum creatinine >2 mg/dL), triglycerides, and body mass index (BMI) were positive predictors of low HDL-C. However, male gender, total cholesterol, and heart failure (Killip class score ≥3) were negative predictors of low HDL-C. Conclusions: Omani ACS patients have a high prevalence of low HDL-C. Renal impairment, triglycerides, and BMI were positive predictors of low HDL-C. The clinical relevance of a low HDL-C abnormality needs to be evaluated in light of the study's limitations (e.g., cross sectional study design as well as the effects of the acute phase reaction and treatment).