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Lipid profile, cardiovascular disease and mortality in a Mediterranean high-risk population: The ESCARVAL-RISK study
Domingo Orozco-Beltran1, Vicente F Gil-Guillen1, Josep Redon2,3,4
1Catedra de Medicina de Familia, Miguel Hernandez University, San Juan de Alicante, Spain.
Insights
Low HDL-cholesterol and high Total/HDL-cholesterol ratios are linked to increased mortality and cardiovascular events in high-risk individuals. These lipid profiles pose a significant population attributable risk for cardiovascular disease.
Area of Science:
- Cardiovascular Medicine
- Lipidology
- Preventive Cardiology
Background:
- Understanding the impact of specific lipid profile components on cardiovascular outcomes in high-risk populations is crucial.
- Standard lipid profiles are commonly used, but their association with mortality and cardiovascular events requires further elucidation in at-risk groups.
Purpose of the Study:
- To assess the association between different components of the standard lipid profile and all-cause mortality.
- To evaluate the link between lipid profile variations and hospitalization due to cardiovascular events (coronary heart disease and stroke) in a high-risk cohort.
Main Methods:
- Prospective registry of over 51,000 high-risk adults (hypertension, dyslipidemia, or diabetes) without prior cardiovascular disease (2008-2012).
- Evaluation of lipid biomarkers, including HDL-cholesterol, Total/HDL-cholesterol ratio, and Triglycerides/HDL-cholesterol ratio.
- Analysis of adjusted rate ratios (aRR) and population attributable risk for primary endpoints: all-cause mortality, coronary heart disease, and stroke hospitalizations.
Main Results:
- Low HDL-cholesterol, high Total/HDL-cholesterol, and high Triglycerides/HDL-cholesterol ratios were significantly associated with increased rates of total mortality and hospitalizations for coronary heart disease and stroke.
- Low HDL-cholesterol showed the highest population attributable risk for total mortality (7.70%) and coronary heart disease (11.42%).
- High Total/HDL-cholesterol ratio demonstrated the highest population attributable risk for coronary heart disease hospitalizations (12.47%).
Conclusions:
- In individuals with cardiovascular risk factors, specific lipid parameters like HDL-cholesterol levels and cholesterol ratios (Total/HDL, Triglycerides/HDL) are key predictors of adverse cardiovascular outcomes.
- These lipid markers represent significant population attributable risks for cardiovascular disease, highlighting their importance in risk assessment and management.
Introduction:
The potential impact of targeting different components of an adverse lipid profile in populations with multiple cardiovascular risk factors is not completely clear. This study aims to assess the association between different components of the standard lipid profile with all-cause mortality and hospitalization due to cardiovascular events in a high-risk population.
Methods:
This prospective registry included high risk adults over 30 years old free of cardiovascular disease (2008-2012). Diagnosis of hypertension, dyslipidemia or diabetes mellitus was inclusion criterion. Lipid biomarkers were evaluated. Primary endpoints were all-cause mortality and hospital admission due to coronary heart disease or stroke. We estimated adjusted rate ratios (aRR), absolute risk differences and population attributable risk associated with adverse lipid profiles.
Results:
51,462 subjects were included with a mean age of 62.6 years (47.6% men). During an average follow-up of 3.2 years, 919 deaths, 1666 hospitalizations for coronary heart disease and 1510 hospitalizations for stroke were recorded. The parameters that showed an increased rate for total mortality, coronary heart disease and stroke hospitalization were, respectively, low HDL-Cholesterol: aRR 1.25, 1.29 and 1.23; high Total/HDL-Cholesterol: aRR 1.22, 1.38 and 1.25; and high Triglycerides/HDL-Cholesterol: aRR 1.21, 1.30, 1.09. The parameters that showed highest population attributable risk (%) were, respectively, low HDL-Cholesterol: 7.70, 11.42, 8.40; high Total/HDL-Cholesterol: 6.55, 12.47, 8.73; and high Triglycerides/HDL-Cholesterol: 8.94, 15.09, 6.92.
Conclusions:
In a population with cardiovascular risk factors, HDL-cholesterol, Total/HDL-cholesterol and triglycerides/HDL-cholesterol ratios were associated with a higher population attributable risk for cardiovascular disease compared to other common biomarkers.
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