High-density lipoprotein cholesterol level and smoking modify the prognosis of patients with coronary vasospasm.

A cardiovascular event analysis was performed in a subset of 80 consecutive patients with vasospastic coronary artery disease. During the follow-up period (30 +/- 2 months, mean +/- SD), 9 patients had vascular accidents, including acute myocardial infarction, unstable angina, and stroke (Group A), while the remaining 71 patients were eventfree (Group B). Serum total-cholesterol, low-density lipoprotein cholesterol, and triglyceride levels were not different between the two groups at the baseline as well as after follow-up. However, the HDL-C level at baseline was significantly lower in Group A (33.5 +/- 2.6 mg/dl) than in Group B (41.9 +/- 1.7 mg/dl, p < 0.05). The HDL-C level increased significantly during the follow-up in Group B (delta HDL-C: 6.2 +/- 1.2 mg/dl, p < 0.01), but not in Group A (delta HDL-C: -3.2 +/- 2.7 mg/dl). The HDL-C level after follow-up was significantly lower in Group A (30.3 +/- 2.9 mg/dl) than in Group B (48.1 +/- 1.5 mg/dl, p < 0.01). Current smokers at the end of the follow-up period were more prevalent in Group A (67%) than in Group B (11%, p < 0.01). Cardiovascular accidents occurred more often in current smokers (6/14, 43%) at the end of the follow-up than in current nonsmokers, including quitters (3/66, 5%; p < 0.05). The HDL-C level was increased significantly (delta HDL: 6.2 +/- 1.3 mg/dl, p < 0.01) in the latter patients, but not in the former (delta HDL: -0.4 +/- 2.9 mg/dl).(ABSTRACT TRUNCATED AT 250 WORDS)