ABSTRACT

Objective:

Hyperlipidemia is a well-known metabolic indicator of cardiovascular risk, but its role in pulmonary hypertension (PH) has not yet been fully determined. Therefore, we evaluated whether the levels of total cholesterol (TC)/high-density lipoprotein (HDL), low-density lipoprotein (LDL)/HDL, and triglyceride/HDL, which are new applications in clinical practice, change in patients with PH.

Material and Methods:

Eighty-nine males (51.7%) and 83 females (48.3%) with systolic pulmonary arterial pressure (sPAP) of 40 mmHg and above, who underwent transthoracic echocardiography, were included in the study. Ratios of TC/HDL, LDL/HDL, and triglyceride/HDL were obtained from the fasting blood biochemistry values of the patients. These values were statistically compared using the SPSS 21 program.

Results:

A statistically significant positive correlation was found between sPAP values obtained echocardiographically and the ratios of TC/HDL, LDL/HDL, and triglyceride/HDL (respectively; p<0.001, r=0.285; p<0.001, r=0.310; and p=0.035, r=0.161). The likelihood of severe PH (sPAP ≥60 mmHg) was predicted with TK/HDL ratio (≥4.1) with 64% sensitivity - 54% specificity, LDL/HDL ratio (≥2.6) with 60% sensitivity - 56% specificity, and triglyceride/HDL ratio (≥2.7) with 60% sensitivity - 51% specificity (respectively, p<0.001, p=0.002, p=0.024).

Conclusions:

In conclusion, our study highlights the significance of lipidemic changes in PH by providing innovative diagnostic and prognostic biomarkers. These findings have the potential to reshape PH management strategies.

Keywords: Pulmonary hypertension, TC/HDL, LDL/HDL, triglyceride/HDL

References

West J, Niswender KD, Johnson JA, Pugh ME, Gleaves L, Fessel JP, et al. A potential role for insulin resistance in experimental pulmonary hypertension. Eur Respir J 2013;41(4):861-871.

Hemnes AR, Brittain EL, Trammell AW, Fessel JP, Austin ED, Penner N, et al. Evidence for right ventricular lipotoxicity in heritable pulmonary arterial hypertension. Am J Respir Crit Care Med 2014;189(3):325-334.

Ussavarungsi K, Thomas CS, Burger CD. Prevalence of metabolic syndrome in patients with pulmonary hypertension. Clin Respir J 2017;11(6):721-726.

Hemnes AR, Luther JM, Rhodes CJ, Burgess JP, Carlson J, Fan R, et al. Human PAH is characterized by a pattern of lipid-related insulin resistance. JCI Insight 2019;4(1):e123611.

Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010;23(7):685-713.

Brunner NW, Skhiri M, Fortenko O, Hsi A, Haddad F, Khazeni N, et al. Impact of insulin resistance on ventricular function in pulmonary arterial hypertension. J Heart Lung Transplant 2014;33(7):721-726.

Zamanian RT, Hansmann G, Snook S, Lilienfeld D, Rappaport KM, Reaven GM, et al. Insulin resistance in pulmonary arterial hypertension. Eur Respir J 2009;33(2):318-324.

Heresi GA, Aytekin M, Newman J, DiDonato J, Dweik RA. Plasma levels of high-density lipoprotein cholesterol and outcomes in pulmonary arterial hypertension. Am J Respir Crit Care Med 2010;182(5):661-668.

Zhao QH, Peng FH, Wei H, He J, Chen FD, Di RM, et al. Serum high-density lipoprotein cholesterol levels as a prognostic indicator in patients with idiopathic pulmonary arterial hypertension. Am J Cardiol 2012;110(3):433-439.

Jankov RP, Luo X, Cabacungan J, Belcastro R, Frndova H, Lye SJ, et al. Endothelin-1 and O2-mediated pulmonary hypertension in neonatal rats: a role for products of lipid peroxidation. Pediatr Res 2000;48(3):289-298.

Kopeć G, Waligóra M, Tyrka A, Jonas K, Pencina MJ, Zdrojewski T, et al. Low-density lipoprotein cholesterol and survival in pulmonary arterial hypertension. Sci Rep 2017;7:41650.

Al-Naamani N, Palevsky HI, Lederer DJ, Horn EM, Mathai SC, Roberts KE, et al. Prognostic Significance of Biomarkers in Pulmonary Arterial Hypertension. Ann Am Thorac Soc 2016;13(1):25-30.

Wang GF, Guan LH, Zhou DX, Chen DD, Zhang XC, Ge JB. Serum High-Density Lipoprotein Cholesterol is Significantly Associated with the Presence and Severity of Pulmonary Arterial Hypertension: A Retrospective Cross-Sectional Study. Adv Ther 2020;37(5):2199-2209.

Jonas K, Magoń W, Waligóra M, Seweryn M, Podolec P, Kopeć G. High‑density lipoprotein cholesterol levels and pulmonary artery vasoreactivity in patients with idiopathic pulmonary arterial hypertension. Pol Arch Intern Med 2018;128(7-8):440-446.

Pašková U. Lipid profile and risks of cardiovascular diseases in conditions of rheumatoid arthritis. Ceska Slov Farm 2019;68(6):219-228.

Fakhry B, Peterson L, Comhair SAA, Sharp J, Park MM, Wilson Tang WH et al. Blood Cholesterol and Triglycerides Associate with Right Ventricular Function in Pulmonary Hypertension.

Li C, Yan L, Xu J. [Correlations between lipid ratio/oxidative stress status in COPD patients and pulmonary hypertension
as well as prognosis]. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2016;41(11):1168-1174.

The Relationship Between Systolic Pulmonary Arterial Pressure Determined Echocardiographically and Blood Lipid Levels

ABSTRACT

References