Isolated Low HDL Cholesterol and CV Disease Risk

Study Questions:

Are high-density lipoprotein cholesterol (HDL-C) levels inversely associated with cardiovascular disease (CVD) risk?

Methods:

Data from the Framingham Heart Study offspring cohort were used for the present study. Only participants without known CVD, who were followed between 1987 and 2011, were included. Low HDL-C (<40 mg/dl in men and <50 mg/dl in women) was defined as isolated if triglycerides (TGs) and low-density lipoprotein cholesterol (LDL-C) were both low (<100 mg/dl). Low versus high HDL-C phenotypes were also compared using higher thresholds for TGs (150 mg/dl) and LDL-C (130 mg/dl).

Results:

A total of 3,590 men and women were included in the analysis. In general, the baseline characteristics of participants with isolated high and low HDL-C groups were similar, regardless of TG and LDL-C measures. Participants with isolated low HDL-C were characterized by a relatively normal mean body mass index, systolic blood pressure, and a low prevalence of diabetes mellitus (6%) in contrast to low HDL-C groups with a higher TG phenotype (≥100 mg/dl). Compared with isolated low HDL-C, CVD risks were higher when low HDL-C was accompanied by LDL-C ≥100 mg/dl and TGs <100 mg/dl (odds ratio [OR], 1.3 [1.0, 1.6]), TGs ≥100 mg/dl and LDL-C <100 mg/dl (OR, 1.3 [1.1, 1.5]), or TGs and LDL-C ≥100 mg/dl (OR, 1.6 [1.2, 2.2]), after adjustment for covariates. Similar associations were observed when low HDL-C was analyzed with higher thresholds for TGs (≥150 mg/dl) and LDL-C (≥130 mg/dl). In contrast, compared with isolated low HDL-C, high HDL-C was associated with 20-40% lower CVD risk except when TGs and LDL-C were elevated.

Conclusions:

The investigators concluded that CVD risk as a function of HDL-C phenotypes is modulated by other components of the lipid panel.

Perspective:

These data suggest that HDL-C levels may be clinically useful in identifying higher-risk patients, but only in relation to other factors such as LDL-C and TG levels.

Clinical Topics: Diabetes and Cardiometabolic Disease, Clinical Topic Collection: Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins

Keywords: Blood Pressure, Body Mass Index, Cardiovascular Diseases, Cholesterol, HDL, Cholesterol, LDL, Diabetes Mellitus, Dyslipidemias, Lipoproteins, HDL, Primary Prevention, Risk Factors, Triglycerides


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