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Low High-Density Lipoprotein Cholesterol to Monitor Long-Term Average Increased Triglycerides
Anne Langsted1,2, Anne Marie Reimer Jensen1,2, Anette Varbo1,2
1Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.
Insights
Low high-density lipoprotein (HDL) cholesterol effectively monitors long-term high triglycerides and remnant cholesterol. This finding is similar to how high hemoglobin A1c (HbA1c) tracks high glucose levels.
Area of Science:
- Cardiovascular Disease Research
- Lipid Metabolism Studies
- Biomarker Discovery
Background:
- Elevated triglyceride-rich remnants are a known causal risk factor for ischemic cardiovascular disease.
- Monitoring long-term triglyceride and remnant cholesterol levels is crucial for cardiovascular risk assessment.
- Current monitoring methods may not fully capture long-term trends effectively.
Purpose of the Study:
- To test the hypothesis that low high-density lipoprotein (HDL) cholesterol can serve as a long-term monitoring marker for high triglycerides/remnant cholesterol.
- To establish an analogy between HDL cholesterol monitoring for triglycerides and HbA1c monitoring for glucose.
- To investigate the relationship between HDL cholesterol, triglycerides, and cardiovascular risk.
Main Methods:
- Cross-sectional analysis of 108,731 individuals.
- Dynamic analysis of 1,313 individuals with repeated lipid measurements.
- Short-term (fat load) and long-term (10-year interval) studies involving 305 and 10,479 individuals, respectively.
Main Results:
- HDL cholesterol showed a significant inverse association with triglycerides and remnant cholesterol (R2 = 0.26).
- Short-term and long-term analyses demonstrated that low HDL cholesterol consistently reflected high triglyceride levels over time.
- In prospective analysis, increased triglycerides/remnant cholesterol were linked to myocardial infarction risk, but this association diminished when HDL cholesterol monitoring was removed.
Conclusions:
- Low HDL cholesterol is a stable and reliable indicator of average high triglycerides and remnant cholesterol.
- This suggests low HDL cholesterol can be utilized for long-term monitoring of average high triglycerides/remnant cholesterol.
- The findings support using low HDL cholesterol as a practical biomarker analogous to HbA1c for glucose monitoring.
Context:
Increased triglyceride-rich remnants represent a causal risk factor for ischemic cardiovascular disease.
Objective:
We tested the hypothesis that low high-density lipoprotein (HDL) cholesterol can be used to monitor long-term high triglycerides/remnant cholesterol, just as high hemoglobin A1c (HbA1c) can be used to monitor long-term high glucose levels.
Design, Setting, Participants, And Interventions:
We studied cross-sectionally 108 731 individuals, dynamically 1313 individuals with lipid measurement at 10 repeated visits, short-term 305 individuals during a fat load, and long-term 10 479 individuals with 2 lipid measurements 10 years apart.
Main Outcome Measures:
Levels of HDL cholesterol and triglycerides.
Results:
Cross-sectionally, HDL cholesterol was inversely associated with triglycerides (R2 = 0.26) and remnant cholesterol (R2 = 0.26). Dynamically, major changes in triglyceride levels from measurement to measurement were mimicked by corresponding modest changes in HDL cholesterol. In the short-term after a fat load, median triglycerides increased 96% while HDL cholesterol decreased only 1%. Long-term, in individuals with measurements 10 years apart, those who initially had the highest triglycerides and corresponding lowest HDL cholesterol, still had highest triglycerides and lowest HDL cholesterol 10 years later. Prospectively, individuals with increased triglycerides/remnant cholesterol had increased risk of myocardial infarction; however, when the HDL cholesterol monitoring was removed, increased triglycerides/remnant cholesterol were largely no longer associated with increased risk of myocardial infarction.
Conclusions:
Low HDL cholesterol is a stable marker of average high triglycerides/remnant cholesterol. This suggests that low HDL cholesterol can be used to monitor long-term average high triglycerides and remnant cholesterol, analogous to high HbA1c as a long-term monitor of average high glucose levels.
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