ArticleLipids in health and disease2026
Preoperative LDL-C and mortality after cardiac valve surgery: a retrospective cohort study on the mediating role of inflammatory risk.
Article in Lipids in health and disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe 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.
methods1,304 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.
resultsMultivariable 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.
conclusionLower preoperative LDL-C levels are independently related with higher 30-day mortality following cardiac valve surgery, potentially mediated by the activation of inflammatory pathways.
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