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Background <p>The connection between low-density lipoprotein cholesterol (LDL-C) levels and postoperative outcomes following cardiac valve surgery (CVS) remains controversial. Therefore, this research aimed to study the connection of LDL-C levels with the incidence of adverse clinical outcomes in patients undergoing CVS.</p> Methods <p>1,304 patients undergoing first-time CVS were identified from the MIMIC-IV database. Participants were split into two groups based on admission LDL-C levels: a low LDL-C group (&lt; 1.4 mmol/L, <i>n</i> = 215) as well as a high LDL-C one (≥ 1.4 mmol/L, <i>n</i> = 1,089). The main endpoint was 30-day all-cause mortality (ACM), with secondary endpoints including in-hospital, 90-, 180- and 365-day ACM rates. The connection between preoperative LDL-C levels and clinical outcomes was evaluated via survival analysis, mediation analysis, and subgroup analyses.</p> Results <p>Multivariable Cox regression analysis demonstrated preoperative LDL-C level served as an independent protective factor against 30-day ACM following cardiac valve surgery (adjusted HR: 0.594; 95% CI: 0.368–0.960). In stratified analysis, patients in the higher LDL-C tertile exhibited a remarkably lower mortality risk (HR: 0.285; 95% CI: 0.134–0.604). Consistent subgroup analyses validated these findings’ robustness across all clinically relevant subgroups. Notably, mediation analysis provided mechanistic evidence that the mortality-increasing effect of lower LDL-C levels may be partially mediated through activation of systemic inflammation.</p> Conclusion <p>Lower preoperative LDL-C levels are independently related with higher 30-day mortality following cardiac valve surgery, potentially mediated by the activation of inflammatory pathways.</p>

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Preoperative LDL-C and mortality after cardiac valve surgery: a retrospective cohort study on the mediating role of inflammatory risk

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月14日

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  • Ruiyuan Huang,
  • Siyi Liu,
  • Xiaolan Ouyang,
  • Qiuying Li,
  • Qiuyu Wang,
  • Shangfang Li,
  • Xinyan Hong,
  • Zhiqiang Nie,
  • Liming Lei

摘要

Background

The connection between low-density lipoprotein cholesterol (LDL-C) levels and postoperative outcomes following cardiac valve surgery (CVS) remains controversial. Therefore, this research aimed to study the connection of LDL-C levels with the incidence of adverse clinical outcomes in patients undergoing CVS.

Methods

1,304 patients undergoing first-time CVS were identified from the MIMIC-IV database. Participants were split into two groups based on admission LDL-C levels: a low LDL-C group (< 1.4 mmol/L, n = 215) as well as a high LDL-C one (≥ 1.4 mmol/L, n = 1,089). The main endpoint was 30-day all-cause mortality (ACM), with secondary endpoints including in-hospital, 90-, 180- and 365-day ACM rates. The connection between preoperative LDL-C levels and clinical outcomes was evaluated via survival analysis, mediation analysis, and subgroup analyses.

Results

Multivariable Cox regression analysis demonstrated preoperative LDL-C level served as an independent protective factor against 30-day ACM following cardiac valve surgery (adjusted HR: 0.594; 95% CI: 0.368–0.960). In stratified analysis, patients in the higher LDL-C tertile exhibited a remarkably lower mortality risk (HR: 0.285; 95% CI: 0.134–0.604). Consistent subgroup analyses validated these findings’ robustness across all clinically relevant subgroups. Notably, mediation analysis provided mechanistic evidence that the mortality-increasing effect of lower LDL-C levels may be partially mediated through activation of systemic inflammation.

Conclusion

Lower preoperative LDL-C levels are independently related with higher 30-day mortality following cardiac valve surgery, potentially mediated by the activation of inflammatory pathways.