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High-density lipoprotein cholesterol, a protective or a risk factor for developing coronary heart disease? Tehran
Seyed Saeed Hashemi Nazari1, Maryam Shakiba2, Davood Khalili3
1Department of Epidemiology, School of Public Health and Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Insights
High-density lipoprotein cholesterol (HDL-C) shows different effects on coronary heart disease (CHD) risk in women. HDL-C increases CHD risk in premenopausal women but decreases it in postmenopausal women.
Area of Science:
- Cardiovascular Medicine
- Epidemiology
- Women's Health
Background:
- Controversial findings exist regarding the protective effect of high-density lipoprotein cholesterol (HDL-C) against coronary heart disease (CHD).
- Understanding HDL-C's role in different life stages is crucial for cardiovascular risk assessment.
Purpose of the Study:
- To investigate the differential impact of HDL-C on CHD risk in premenopausal versus postmenopausal women.
- To clarify the relationship between HDL-C levels and incident CHD across the menopausal transition.
Main Methods:
- A cohort of 3778 women aged 30-74 years, free of cardiovascular disease, was recruited between 1999-2001 and followed until 2010.
- Baseline HDL-C and other CHD risk factors were measured.
- Multivariable Cox proportional hazard models were used to analyze the association between HDL-C and CHD events.
Main Results:
- Over a median follow-up of 9.6 years, 228 CHD events occurred.
- In postmenopausal women, increased HDL-C was associated with a reduced hazard of CHD (HR per SD increase: 0.76; 95% CI, 0.63-0.92).
- In premenopausal women, increased HDL-C was associated with an increased hazard of CHD (HR at age 30 per SD increase: 2.67; 95% CI, 0.98-7.29), with the risk decreasing annually with age.
Conclusions:
- HDL-C exhibits distinct effects on CHD risk depending on menopausal status.
- Premenopausal women experience an increased CHD hazard with higher HDL-C, a trend that diminishes with age.
- Postmenopausal women show an inverse relationship, where higher HDL-C levels are linked to lower CHD risk.
Background:
Recently, there are controversial findings on protective effect of high-density lipoprotein cholesterol (HDL-C) against coronary heart disease (CHD) in some population.
Objective:
We aim to determine the effect of HDL-C on CHD in premenopausal and postmenopausal women.
Methods:
Between February 1999 and August 2001, 3778 women aged 30 to 74 y, free of clinical cardiovascular diseases, were recruited and followed up to March 2010. HDL-C and other CHD risk factors were measured at baseline. Using multivariable Cox proportional hazard model, the adjusted hazard ratio was calculated.
Results:
During a median follow-up of 9.6 y, a total of 228 new CHD events occurred. In postmenopausal women, the adjusted hazard ratio for each standard deviation increase in HDL-C was 0.76 (95% confidence interval, 0.63-0.92). Among premenopausal women, a time varying model was fitted; the adjusted hazard ratio for each standard deviation increase of HDL-C among 30-year-old women was 2.67 (95% confidence interval, 0.98-7.29) but decreased by 5% for each year increase of age.
Conclusions:
Different effects of HDL-C in premenopausal and postmenopausal women were identified. During premenopausal period, the hazard of CHD increased by any increase of HDL-C level, but the amount of this increment gradually decreased over time, whereas during postmenopausal period, the hazard of CHD was inversely associated with HDL-C level.