Extremely elevated HDL-cholesterol levels are not associated with increased carotid intima-media thickness: data from ELSA Brasil

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There is evidence that extremely elevated high-density lipoprotein cholesterol (HDL-c), that is, hyperalphalipoproteinemia (HALP) may indicate dysfunctional HDL, conferring increased cardiovascular risk. We studied carotid intima-media thickness (cIMT) a marker of subclinical vascular disease according to HDL-c distribution. cIMT was studied in subjects with "normal" HDL-c levels (HDL-c 40-50mg/dL for men; 50-60mg/dL for women, mean 49.6±5.7mg/dL, n=3226); in those with HALP (HDL-c ≥90mg/dL for both sexes, mean 101.2±10mg/dL, n=264) and according to HDL-c quintile distribution (n=9779). Multiple linear regression was used to test the association of HDL-c and cIMT. Subjects with HALP were older (54.5±9.6 vs 51.1±8.8years, P<.001); more frequently females (86.4% vs 49%, P<.001); and presented a lower burden of risk factors: hypertension (24.6% vs 32.7%, P=.009), diabetes (10.2% vs 20.4%, P<.001), and obesity (18.6% vs 37.6%, P<.001). A similar profile was seen with higher HDL-c quintiles in the whole study population. When compared to normal HDL-c values, HALP was associated with lower maximal cIMT (0.779±0.189mm vs 0.818±0.200mm, P=.002), and there was a lower prevalence of individuals with cIMT ≥ 75(th) percentile for age and gender or high cIMT (17.5% vs 26.2%, P=.003). After multivariate analysis, no association was seen between HALP and increasing cIMT values, indeed the 5(th) HDL-c quintile was associated with lower risk of high cIMT (OR= 0.80; 95% CI= 0.68-0.95). HALP is associated with lower cIMT and does not indicate a pro-atherogenic phenotype.