Admission Low-Density Lipoprotein Cholesterol Stratified by Circulating CD14++CD16+ Monocytes and Risk for Recurrent Cardiovascular Events Following ST Elevation Myocardial Infarction: Lipid Paradox Revised

J Cardiovasc Transl Res. 2020 Dec;13(6):916-927. doi: 10.1007/s12265-020-10015-6. Epub 2020 Jun 18.


Lower level of low-density lipoprotein cholesterol (LDL-C) is paradoxically associated with increased mortality in ST elevation myocardial infarction (STEMI) patients. The underlying mechanism remains unclear. In a cohort of 220 de novo STEMI patients receiving timely primary percutaneous coronary intervention, admission LDL-C was negatively associated with circulating CD14++CD16+ monocyte counts. Moreover, admission LDL-C < 85 mg/dL was associated with increased risk for major adverse cardiovascular events (MACE) during a median follow-up of 2.7 years. After categorizing the patients according to the cutoff values of 85 mg/dL for LDL-C and the median for CD14++CD16+ monocytes, low LDL-C-associated MACE risk was only observed in those with high CD14++CD16+ monocyte counts (low LDL-C/high CD14++CD16+ monocytes vs. low LDL-C/low CD14++CD16+ monocytes: hazard ratio 5.38, 95% confidence interval 1.52 to 19.06, P = 0.009). This work provided the proof-of-principle evidence indicating a role of CD14++CD16+ monocytes in risk stratification of STEMI patients presenting with low LDL-C level. Graphical abstract.

Keywords: Lipid paradox; Low-density lipoprotein cholesterol; Monocyte subsets; Prognosis; ST elevation myocardial infarction.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Biomarkers / blood
  • Cholesterol, LDL / blood*
  • Female
  • GPI-Linked Proteins / blood
  • Humans
  • Immunity, Innate
  • Lipopolysaccharide Receptors / blood*
  • Male
  • Middle Aged
  • Monocytes / immunology
  • Monocytes / metabolism*
  • Patient Admission*
  • Percutaneous Coronary Intervention / adverse effects
  • Proof of Concept Study
  • Receptors, IgG / blood*
  • Recurrence
  • Risk Assessment
  • Risk Factors
  • ST Elevation Myocardial Infarction / blood*
  • ST Elevation Myocardial Infarction / diagnosis
  • ST Elevation Myocardial Infarction / immunology
  • ST Elevation Myocardial Infarction / therapy
  • Time Factors
  • Treatment Outcome


  • Biomarkers
  • CD14 protein, human
  • Cholesterol, LDL
  • FCGR3B protein, human
  • GPI-Linked Proteins
  • Lipopolysaccharide Receptors
  • Receptors, IgG