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Hyperuricemia increases the risk of cardiovascular mortality associated with very high HdL-cholesterol level

Paolo Palatini1, Agostino Virdis2, Stefano Masi2

  • 1Department of Medicine, Studium Patavinum, University of Padova, Padua, Italy.

Nutrition, Metabolism, and Cardiovascular Diseases : NMCD
|January 15, 2023
PubMed

Insights

Very high HDL-cholesterol increases cardiovascular mortality risk in women, especially when combined with hyperuricemia. This suggests inflammation may worsen the impact of high HDL-cholesterol on heart health.

Area of Science:

  • Cardiovascular Health
  • Metabolic Disorders
  • Epidemiology

Background:

  • The relationship between elevated high-density lipoprotein cholesterol (HDL-C) and cardiovascular mortality (CVM) is complex and may be influenced by other factors.
  • Hyperuricemia, a condition of high uric acid levels, is increasingly recognized for its potential role in cardiovascular disease.

Purpose of the Study:

  • To investigate if hyperuricemia modifies the association between very high HDL-cholesterol levels and the risk of CVM.
  • To explore sex-specific differences in this association.

Main Methods:

  • Multivariable Cox regression analyses were performed on data from 18,072 participants in the URRAH study.
  • Participants were stratified by sex and HDL-cholesterol categories, with a median follow-up of 11.4 years.
  • Analyses examined the association between high HDL-cholesterol and CVM, considering the presence of hyperuricemia and age.

Main Results:

  • A J-shaped association between HDL-cholesterol and CVM was observed in the overall population, with the highest risk in the highest HDL-cholesterol group (>80 mg/dL).
  • This association was significant only in women, not in men.
  • In women, concomitant hyperuricemia significantly amplified the CVM risk associated with high HDL-cholesterol (HR 1.61), particularly in older women (>70 years, HR 1.83).
  • The inclusion of Body Mass Index (BMI) in the models attenuated these associations.

Conclusions:

  • Very high HDL-cholesterol levels are linked to increased CVM risk in women, following a J-shaped pattern.
  • Hyperuricemia exacerbates this risk, suggesting that a pro-inflammatory or oxidative state may mediate the detrimental cardiovascular effects of high HDL-cholesterol.
  • These findings highlight the importance of considering uric acid levels in women with very high HDL-cholesterol.
Abstract

Keywords:
CardiovascularHDL-CholesterolHURRAHMortalityUric acid

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