HDL (High-Density Lipoprotein) Metrics and Atherosclerotic Risk in Women

Area of Science:

• Cardiovascular Disease
• Endocrinology
• Lipid Metabolism

Background:

• High-density lipoprotein cholesterol (HDL-C) is a traditional cardiovascular risk marker.
• HDL particle number (HDL-P) measured by ion-mobility may offer a more accurate assessment of HDL's antiatherogenic potential.
• The role of HDL in cardiovascular disease risk may differ between HDL-C and HDL-P, particularly in postmenopausal women.

Purpose of the Study:

• To evaluate the associations of HDL-C and HDL-P with carotid intima-media thickness (cIMT) and carotid plaque in women.
• To assess how age at and time since menopause modify these associations.
• To determine if HDL-C is consistently cardioprotective in postmenopausal women.

Main Methods:

• Analysis of 1380 women from the Multi-Ethnic Study of Atherosclerosis (MESA) cohort.
• Measurement of HDL-C and HDL-P using ion-mobility.
• Assessment of carotid intima-media thickness (cIMT) and carotid plaque presence.
• Statistical adjustments for potential confounders and interaction analyses by menopausal status.

Main Results:

• Higher HDL-P, but not HDL-C, was associated with lower cIMT (P=0.001).
• Higher HDL-C, but not HDL-P, was associated with increased carotid plaque presence (P=0.04).
• Time since menopause modified the association between large HDL-P and cIMT; associations were adverse near menopause and protective later in life. Proatherogenic HDL-C associations with plaque were strongest in women >10 years postmenopause with later menopause onset.

Conclusions:

• Elevated HDL-C may not confer cardioprotection in all postmenopausal women.
• The antiatherogenic capacity of large HDL-P may be compromised near menopause.
• Assessing HDL quality in the context of menopause transition is crucial for understanding cardiovascular disease risk.