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High density lipoprotein cholesterol is not a major risk factor for ischaemic heart disease in British men
Insights
High-density lipoprotein cholesterol (HDL cholesterol) is not a major risk factor for ischemic heart disease. Non-HDL cholesterol is a more significant predictor of heart disease risk in men.
Area of Science:
- Cardiovascular epidemiology
- Lipid metabolism
- Preventive cardiology
Background:
- Ischemic heart disease (IHD) remains a leading cause of mortality globally.
- The role of high-density lipoprotein cholesterol (HDL cholesterol) in IHD aetiology has been debated.
- Non-high-density lipoprotein cholesterol (non-HDL cholesterol) is increasingly recognized as a significant atherogenic lipid fraction.
Purpose of the Study:
- To investigate the association between HDL cholesterol and non-HDL cholesterol levels and the risk of major ischemic heart disease.
- To determine the relative predictive power of HDL cholesterol and non-HDL cholesterol for IHD risk.
- To compare findings with other prospective studies on lipid profiles and cardiovascular risk.
Main Methods:
- Prospective cohort study involving 7415 men aged 40-59.
- Measurement of serum HDL cholesterol and total cholesterol at baseline.
- Follow-up for an average of 4.2 years to register 193 cases of major ischemic heart disease.
- Statistical adjustment for potential confounders including age, BMI, blood pressure, and smoking.
Main Results:
- Mean HDL cholesterol was lower in men with IHD, but this difference was non-significant after multivariate adjustment.
- Mean non-HDL cholesterol was significantly higher in men with IHD, even after adjustment for other risk factors.
- Men in the highest quintile of non-HDL cholesterol had over three times the risk of major IHD compared to those in the lowest quintile.
- Non-HDL cholesterol emerged as a more potent predictor of IHD risk than the HDL to total cholesterol ratio.
Conclusions:
- HDL cholesterol is unlikely to be a major independent risk factor for ischemic heart disease.
- Non-HDL cholesterol is a significant and powerful predictor of major ischemic heart disease risk.
- These findings align with other large-scale prospective studies, reinforcing the clinical importance of non-HDL cholesterol assessment.
Abstract:
The concentration of high density lipoprotein cholesterol (HDL cholesterol) in serum was measured at initial examination in a large prospective study of men aged 40-59 drawn from general practices in 24 British towns. After an average follow up of 4.2 years 193 cases of major ischaemic heart disease had been registered in 7415 men in whom both HDL cholesterol and total cholesterol values had been measured. The mean HDL cholesterol concentration was lower in the men with ischaemic heart disease ("cases") compared with other men, but the difference became small and non-significant after adjustment for age, body mass index, blood pressure, cigarette smoking, and concentration of non-HDL cholesterol. The higher mean concentration of non-HDL cholesterol in "cases" remained highly significant after adjustment for other factors. Men in the highest fifth of non-HDL cholesterol values had over three times the risk of major ischaemic heart disease compared with men in the lowest fifth. Multivariate analysis showed that non-HDL cholesterol was a more powerful predictor of risk than the HDL to total cholesterol ratio. These British findings were compared with six other prospective studies. All the larger studies showed similar results, suggesting that HDL cholesterol is not a major risk factor in the aetiology of ischaemic heart disease.