To investigate the association between HDL-C levels and long-term clinical outcomes in patients with non-ischemic dilated cardiomyopathy (DCM).
Approach:
Study Design: Retrospective cohort study enrolling 297 patients with DCM who underwent cardiac magnetic resonance from January 2017 to October 2024.
Endpoints: Primary endpoint: composite of all-cause mortality and heart transplantation; secondary endpoint: heart failure readmission.
Statistical Analysis: Used Kaplan-Meier analysis, Cox regression, restricted cubic spline (RCS), and sensitivity analyses to assess associations.
Key Findings:
41 (13.8%) patients experienced the primary endpoint and 97 (32.7%) the secondary endpoint during a median follow-up of 35 months.
Higher HDL-C levels were associated with significantly better event-free survival for both endpoints (log-rank P < 0.001).
Lower HDL-C was independently associated with increased risk of primary (HR 0.19, 95% CI: 0.05–0.68, P = 0.011) and secondary (HR 0.15, 95% CI: 0.07–0.34, P < 0.001) endpoints.
Adjustment for pulmonary artery systolic pressure attenuated the association between HDL-C and clinical outcomes.
Interpretation:
Lower HDL-C levels were independently associated with adverse outcomes in patients with non-ischemic DCM, with some attenuation observed when adjusting for pulmonary hypertension markers.
Limitations:
Retrospective design may introduce selection bias.
Findings may not be generalizable to all DCM populations.
Conclusion:
HDL-C may serve as a prognostic biomarker for risk stratification in patients with non-ischemic DCM.
