Prevalence, Predictors, and Impact of Low High-Density Lipoprotein Cholesterol on in-Hospital Outcomes Among Acute Coronary Syndrome Patients in the Middle East

Khalid Al-Rasadi1, *, Ibrahim Al-Zakwani2, Mohammad Zubaid3, Amr Ali4, Yasser Bahnacy4, Kadhim Sulaiman5, Wael Al Mahmeed6, Jassim Al Suwaidi7, Dimitri P Mikhailidis8
1 Department of Clinical Biochemistry, Sultan Qaboos University Hospital, Muscat, Oman
2 Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University and Gulf Health Research, Muscat, Oman
3 Department of Medicine, Kuwait University, Kuwait
4 Department of Medicine, Mubarak Alkabeer Hospital, Ministry of Health, Kuwait
5 Department of Cardiology, Royal Hospital, Muscat, Oman
6 Division of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
7 Hamad Medical Corporation, Doha, Qatar
8 Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK

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© Al-Rasadi et al.; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Clinical Biochemistry Sultan Qaboos University Hospital PO Box 38, Al-Khodh, PC-123 Sultanate of Oman; Tel: +968-96780908; Fax: +968-24141786; E-mail:



To estimate the prevalence, predictors, and impact of low high-density lipoprotein cholesterol (HDL-C) on in-hospital outcomes among acute coronary syndrome (ACS) patients in the Middle East.


Data were collected prospectively from 6,266 consecutive patients admitted with a diagnosis of ACS and enrolled in the Gulf Registry of Acute Coronary Events (Gulf RACE). A low HDL-C was defined as a level <40 mg/Dl (1.0 mmol/L) for males and <50 mg/dL (1.3 mmol/L) for females. Analyses were performed using univariate and multivariate statistical techniques.


The overall mean age of the cohort was 56±12 years and majority were males (77%). The overall prevalence of low HDL-C was 62%. During in-hospital stay and at discharge, the majority were on statin therapy (83%) while 10% were on other cholesterol lowering agents. After adjustment of demographic and clinical characteristics, the predictors for low HDL-C were higher body mass index (BMI), prior myocardial infarction (MI), diabetes mellitus, smoking and impaired renal function. Multivariable adjustment revealed that low HDL-C was associated with higher in-hospital mortality (odds ratio (OR), 1.54; 95% CI: 1.06-2.24; p=0.022) and cardiogenic shock (OR, 1.61; 95% CI: 1.20-2.14; p=0.001).


ACS patients in the Middle East have a high prevalence of low HDL-C. Higher BMI, prior MI, diabetes mellitus, smoking, and impaired renal function were predictors of low HDL-C. Significantly higher in-hospital mortality and cardiogenic shock were associated with low HDL-C in men but not in women.

Keywords: High density lipoprotein cholesterol, low density lipoprotein cholesterol, triglycerides, acute coronary syndrome, myocardial infarction, gender, Middle East..