Baseline plasma lipid levels in patients with acute coronary syndrome: Association with 20‐year mortality. The ABC‐5a Study on Heart Disease

Background The relationship between baseline plasma lipid levels during acute coronary syndrome and the outcome has clinical relevance. Methods To evaluate their long‐term prognostic value, we examined 589 patients admitted with acute coronary syndrome at three hospitals. Baseline plasma lipids were assessed on days 1 and 7. Patients were followed for 20 years or until death. Results Virtually, all patients completed follow‐up; 437 (74%) had died: 24% from coronary artery disease/heart failure (CAD/HF), 21% sudden cardiac death (SCD), 16% from other cardiovascular causes and 39% had non‐cardiac death. The incidence rate (IR) of all‐cause mortality was not different among patients with baseline plasma lipids less or greater than the median value. The IR of CAD/HF mortality was not significantly higher among patients with greater than median low‐density lipoprotein (LDL) cholesterol and triglyceride (TG) levels. The IR of non‐cardiac death tended to be lower among patients with greater than median total cholesterol (TC) and LDL levels. Using three levels of adjusted Cox survival models, baseline plasma lipids had no consistent independent or inverse association with all‐cause mortality, even after excluding patients who received statins. Competitive risk survival models for each cause of death revealed that the only hazard of non‐cardiac death was consistently higher among patients with less than or equal to median TC and LDL levels. Conclusion In the present prospective long‐term study, after acute coronary syndrome, baseline plasma lipid levels seem not to be associated with long‐term global mortality. Only an independent inverse association between TC and LDL and non‐cardiac death has been observed.