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Sex and Racial Differences in High-Density Lipoprotein Levels in Acute Coronary Syndromes
Asuka Ozaki1, Katia Bravo-Jaimes2, Carmen Smotherman3
1Cardiovascular Therapeutic Lead Diabetes & Cardiovascular Medical Operations, Sanofi KK, Tokyo, Japan.
Insights
Women and Black individuals with acute coronary syndromes (ACS) showed higher high-density lipoprotein cholesterol (HDL-C) levels. These findings suggest potential differences in cardiovascular risk assessment across demographics.
Area of Science:
- Cardiology
- Biochemistry
- Health Disparities
Background:
- Acute coronary syndromes (ACS) represent a critical area of cardiovascular research.
- Understanding demographic variations in lipid profiles, specifically high-density lipoprotein cholesterol (HDL-C), is crucial for effective patient management.
- Previous research has not fully elucidated sex and racial differences in HDL-C levels among ACS patients.
Purpose of the Study:
- To investigate and compare high-density lipoprotein cholesterol (HDL-C) levels between different sexes and racial groups in patients presenting with acute coronary syndromes (ACS).
- To identify demographic factors associated with variations in HDL-C levels within the ACS population.
Main Methods:
- Retrospective review of 614 patients with ACS from 2009-2012.
- Collection of detailed medical histories and measurement of HDL-C levels within 72 hours of presentation.
- Statistical analysis including Pearson chi-square, Wilcoxon rank sum tests, and analysis of variance to identify independent predictors of HDL-C levels.
Main Results:
- Women and Black patients were more likely to be older, diabetic, and have higher body mass index compared to men and White patients, respectively.
- After adjusting for clinical factors, female sex, Black race, absence of coronary artery disease (CAD), and absence of diabetes were independently associated with higher HDL-C levels.
- Higher HDL-C levels (> 40 mg/dL) were observed more frequently in women and Black individuals with ACS.
Conclusions:
- Women and Black individuals with ACS exhibit higher HDL-C levels, which are generally considered cardio-protective.
- Sex-based differences in HDL-C were significant in White patients but not in Black patients.
- Further research is warranted to explore the clinical relevance and quality of HDL-C in different racial groups for accurate guideline interpretation.
Background:
This study aimed to assess sex and racial differences related to high-density lipoprotein cholesterol (HDL-C) levels in those presenting with acute coronary syndromes (ACS).
Methods:
Records from patients with ACS presenting to the Emergency Department of University of Florida Hospital Jacksonville from 2009 to 2012, were reviewed. Detailed medical history was obtained. HDL-C levels were measured within 72 h of presentation. Pearson chi-square and Wilcoxon rank sum tests were used to compare groups in univariate analysis. Analysis of variance was performed to determine independent predictors of higher HDL-C levels using variable selection.
Results:
Of 2400 patients screened, 614 (382 men and 232 women) met inclusion criteria. Hypertension, chronic kidney disease or prior CAD history was similar between sexes and races. Women were more likely to be older (62.4 vs 58.4 years), diabetic (56.5 vs 36.5%) and have higher body mass index (31.2 vs 30.1 kg/m2). Blacks were more likely to be diabetic (50.3 vs 41.3%). After adjusting for all clinical markers, women and blacks along with absence of CAD or diabetes, were significantly associated with higher HDL-C levels.
Conclusions:
High HDL-C levels (> 40 mg/dL), considered cardio-protective, were seen in women and blacks with ACS more often than in men and whites. Significant differences in HDL-C levels between sexes were seen in whites but not in blacks. Relevance and quality of HDL-C levels in racial groups need further study as this may have important implications in the interpretation of current guidelines.
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