Abstract

Introduction: Higher levels of high density lipoprotein cholesterol (HDL-C) are associated with reduced risk of cardiovascular disease (CVD). However, observational data suggest very high HDL-C may be associated with increased all-cause mortality. We aimed to investigate the relationship between HDL-C and CV mortality and morbidity. Methods: Using data from adults without prior CVD from 5 large U.S.-based cohorts available through NIH BioLINCC (Framingham Cohort Study, Framingham Offspring, Multi-ethnic Study of Atherosclerosis, Atherosclerosis Risk in Communities, and Cardiovascular Health Study), we assessed the association between HDL-C and all-cause death and CVD composite events (CV death, myocardial infarction, angina, or stroke) using Cox proportional hazards models, modeling HDL-C with restricted cubic splines to allow for non-linearity. Adjustment factors included age, race, systolic blood pressure, antihypertensive medications, diabetes, body-mass index, smoking status, low-density lipoprotein cholesterol, and weekly alcohol use. Results: Among 22,569 individuals (median age 56 years, 55% women), median (IQR) HDL-C was 50 mg/dL (41, 62). Those with HDL-C>50 mg/dL were more frequently female, non-smokers, and less obese. Over median follow up of 19.5 years, 6,539 deaths occurred (31% CV deaths). After adjustment for clinical factors, there was a U-shaped association between HDL-C and all-cause death in men, and to a lesser degree in women (Figure). As compared with a reference point of 50 mg/dL, lower HDL-C was associated with higher CVD composite events in both men and women, but higher HDL-C was not associated with increased CVD composite risk in either sex. Conclusions: In this large, U.S.-based study of well-characterized clinical cohorts and long-term follow-up, HDL-C displayed a U-shaped relationship with all-cause death. Low, but not high, HDL-C is associated with higher CVD composite events in both men and women.

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call

Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.