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Changes in high-density lipoprotein cholesterol with risk of Cardiovascular Disease among initially high-density

Hye Jun Kim1, Seogsong Jeong2, Yun Hwan Oh3

  • 1Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea.

Cardiovascular Diabetology
|March 28, 2023
PubMed

Insights

Increases in high-density lipoprotein cholesterol (HDL-C) may raise cardiovascular disease (CVD) risk in individuals with already high HDL-C levels. This association persists regardless of changes in low-density lipoprotein cholesterol (LDL-C).

Area of Science:

  • Cardiovascular Medicine
  • Lipid Metabolism
  • Public Health

Background:

  • High-density lipoprotein cholesterol (HDL-C) has been traditionally viewed as protective against cardiovascular disease (CVD).
  • Previous research often focused on mortality risk or single HDL-C measurements, potentially overlooking dynamic changes.
  • This study investigates the impact of HDL-C level fluctuations in individuals with elevated baseline HDL-C.

Purpose of the Study:

  • To examine the association between changes in HDL-C levels and the incidence of CVD.
  • To specifically analyze this relationship in a cohort with high baseline HDL-C (≥60 mg/dL).
  • To determine if HDL-C increases pose a risk irrespective of low-density lipoprotein cholesterol (LDL-C) changes.

Main Methods:

  • Utilized data from 77,134 participants in the Korea National Health Insurance Service-Health Screening Cohort.
  • Employed Cox proportional hazards regression to analyze the link between HDL-C change and incident CVD over 517,15 person-years.
  • Adjusted for numerous clinical and lifestyle factors, including age, BMI, diabetes, hypertension, smoking, and lipid profiles.

Main Results:

  • Individuals with the largest HDL-C increases showed significantly higher risks of CVD (aHR 1.15) and coronary heart disease (CHD) (aHR 1.27).
  • This elevated risk was observed compared to those with the smallest HDL-C increases.
  • The association between increased HDL-C and higher CHD risk remained significant even when low-density lipoprotein cholesterol (LDL-C) levels decreased (aHR 1.26).

Conclusions:

  • In individuals with high baseline HDL-C, further increases in HDL-C may paradoxically elevate CVD risk.
  • This potential risk increase is independent of changes in LDL-C levels.
  • The findings suggest that escalating HDL-C levels could unintentionally contribute to cardiovascular risk.
Abstract

Keywords:
Cardiovascular diseasesCholesterol, HDLCoronary heart diseaseMass screeningPublic healthStroke.

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