Relationship between serum low-density lipoprotein cholesterol and in-hospital mortality following acute myocardial infarction (the lipid paradox)

Am J Cardiol. 2015 Mar 1;115(5):557-62. doi: 10.1016/j.amjcard.2014.12.006. Epub 2014 Dec 24.


Lipoprotein levels are currently recognized as independent risk factors for long-term cardiovascular events after acute myocardial infarction (AMI). During the acute-phase reaction after AMI, previous studies have reported trends of decreased low-density lipoprotein cholesterol (LDL-C), increased triglycerides, and variable high-density lipoprotein cholesterol (HDL-C) levels. However, the association between LDL-C and HDL-C levels and in-hospital mortality has not been well established following AMI. The relationship between lipid levels and in-hospital all-cause mortality in 115,492 patients hospitalized for AMI (July 2002 to December 2006), registered in the National Registry of Myocardial Infarction (NRMI) 4b-5, was evaluated using multivariable-adjusted logistic regression models. Mean LDL-C was 104 ± 38, HDL-C was 41 ± 14, and triglycerides 143 ± 83 mg/dl. Compared with the lowest quartile of LDL-C (<77 mg/dl), the risk of in-hospital mortality in the second to fourth quartiles was decreased (adjusted odds ratio 0.79, 0.80, and 0.85, respectively). For HDL-C, only those in the lowest quartile (<31 mg/dl) had higher risk of in-hospital mortality (odds ratio 1.20) compared with the highest quartile (≥47 mg/dl). Results from NRMI 4b-5 suggest a lipid paradox, with lower LDL-C levels associated with increased risk of in-hospital mortality, contrary to findings outside the acute setting. Consistent with previous analyses, lowest HDL-C levels were associated with increased in-hospital mortality. In conclusion, further explorations of the relationship between very low levels of LDL-C, myocardial necrosis, and subsequent adverse cardiovascular events are warranted.

MeSH terms

  • Acute-Phase Reaction / blood
  • Aged
  • Aged, 80 and over
  • Cholesterol, HDL / blood*
  • Cholesterol, LDL / blood*
  • Cohort Studies
  • Databases, Factual
  • Female
  • Hospital Mortality*
  • Hospitalization / statistics & numerical data
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Myocardial Infarction / blood*
  • Myocardial Infarction / mortality*
  • Risk Factors
  • Triglycerides / blood
  • United States


  • Cholesterol, HDL
  • Cholesterol, LDL
  • Triglycerides