IDF21-0504 High-density lipoprotein cholesterol and cardiometabolic disease (CMD) in a large cohort study in Southwest China

Abstract

Background: The “good cholesterol” label for high-density lipoprotein cholesterol (HDL-C) has been challenged by recent evidence on the risk of cardiovascular disease increased with elevated HDL-C. Cardiovascular disease (CVD) and diabetes, with a high mortality risk and sharing common pathways of prevention and management strategies, has been considered as major cardiometabolic disease (CMD) and is most common in low- and middle-income countries and areas. In addition, uncertainty remains regarding the relevance of HDL-C for CMD among Chinese population, with higher incidences but limited health-care services in CVD and diabetes. Aim: We aimed to examine the associations of CMD and HDL-C at baseline and its changes in Southwest China. Method: The current study examined data from the Guizhou Population Health Cohort Study (GPHCS) of 9280 participants aged 18 to 95 years recruited from 12 areas since 2010 in Guizhou Province, where located at Southwest China. Participants were followed-up until December 2020 and 7098 of them were eligible for this analysis. CMD was defined as the existence of at least one of the following events including myocardial infarction, ischemic stroke, hemorrhagic stroke, and diabetes. Blood lipid level and disease information were collected at baseline and follow-up. Cox proportional hazards models were used to estimate the risk of CMD associated with baseline level and changes of HDL-C. Sensitive analysis were conducted among participants with or without dyslipidemia. Results: During a median of 6.57 years of follow-up, 908 subjects developed incident CMD. There was a linear-shaped association between baseline HDL-C level and CMD risk by using restricted cubic-spline (RCS) analysis. Compared with subjects at the second quartile of baseline HDL-C, those at the third quartile had 1.22-fold (95%CI: 1.13-1.45) increased risk for CMD after adjustment for age, sex, area, smoking status and body mass index (BMI) at baseline. Similar association was observed between changes of HDL-C and CMD with an adjusted Hazard Ratio (HR) of 1.19 (95%CI: 1.11-1.41). In addition, the risk of co-existence of two or more CMD was positively associated with higher baseline HDL-C level (multi-adjusted HR:1.20, 95%CI:1.11-1.42). Discussion: Elevated HDL-C provided some predictive information for cardiometabolic disease (CMD) in Southwest China.