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Association of High-Density Lipoprotein Parameters and Risk of Heart Failure: A Multicohort Analysis
Ambarish Pandey1, Kershaw V Patel2, Matthew W Segar3
1Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Insights
Higher high-density lipoprotein particle concentration (HDL-P) is linked to reduced heart failure (HF) risk. Conversely, larger HDL particle size is associated with increased HF risk, while HDL cholesterol (HDL-C) showed no significant association.
Area of Science:
- Cardiovascular Medicine
- Lipid Metabolism
- Heart Failure Research
Background:
- High-density lipoprotein (HDL) is traditionally assessed by cholesterol concentration (HDL-C).
- HDL-C has an inverse relationship with atherosclerotic cardiovascular disease.
- The role of HDL particle concentration (HDL-P) and size (HDL-size) in heart failure (HF) risk is less understood.
Purpose of the Study:
- To investigate the association between HDL particle concentration (HDL-P), HDL particle size (HDL-size), HDL cholesterol (HDL-C), and cholesterol content per particle (HDL-C/HDL-P) with overall heart failure (HF) risk.
- To examine these associations in relation to specific HF subtypes: HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF).
Main Methods:
- Analysis of data from four large cohort studies: Atherosclerosis Risk In Communities, Dallas Heart Study, Multi-Ethnic Study of Atherosclerosis, and Prevention of Renal and Vascular End-stage Disease.
- Inclusion of participants without a prior history of HF.
- Utilized adjusted Cox proportional hazards models to assess the associations of HDL-P, HDL-size, HDL-C, and HDL-C/HDL-P with incident HF events.
Main Results:
- Among 16,925 participants followed for a median of 11.4 years, 612 incident HF events occurred.
- Higher HDL-P was significantly associated with a lower risk of overall HF (HR: 0.76).
- Larger HDL-size was significantly associated with a higher risk of overall HF (HR: 1.27).
- No significant association was found between HDL-C and HF risk.
- Higher HDL-C/HDL-P was significantly associated with increased overall HF risk (HR: 1.29).
Conclusions:
- Increased HDL particle concentration (HDL-P) is associated with a reduced risk of heart failure.
- Larger HDL particle size is linked to an elevated risk of heart failure.
- HDL cholesterol (HDL-C) levels did not show a significant association with HF risk after adjusting for cardiovascular risk factors.
Background:
High-density lipoprotein (HDL) is commonly characterized by its cholesterol concentration (HDL-C) and inverse association with atherosclerotic cardiovascular disease.
Objectives:
The authors sought to evaluate the association of HDL particle concentration (HDL-P), HDL particle size (HDL-size), HDL-C, and cholesterol content per particle (HDL-C/HDL-P) with risk of overall heart failure (HF) and subtypes.
Methods:
Participants from the Atherosclerosis Risk In Communities Study, Dallas Heart Study, Multi-Ethnic Study of Atherosclerosis, and Prevention of Renal and Vascular End-stage Disease studies without HF history were included. Associations of HDL-P, HDL-size, HDL-C, and HDL-C/HDL-P with risk of overall HF, HF with reduced and preserved ejection fraction were assessed using adjusted Cox models.
Results:
Among 16,925 participants (53.5% women; 21.8% Black), there were 612 incident HF events (3.6%) (HF with reduced ejection fraction, 309 [50.5%]; HF preserved ejection fraction, 303 [49.5%]) over median follow-up of 11.4 years. In adjusted models, higher HDL-P was significantly associated with lower HF risk (HR of highest vs lowest tertile of HDL-P: 0.76 [95% CI: 0.62-0.93]). Larger HDL-size was significantly associated with higher overall HF risk (HR of largest vs smallest tertile of HDL-size: 1.27 [95% CI: 1.03-1.58]). HF risk associated with HDL-P and HDL-size was similar for HF subtypes. In adjusted analyses, there was no significant association between HDL-C and HF risk. Higher HDL-C/HDL-P was significantly associated with higher overall HF risk (HR of highest vs lowest tertile of HDL-C/HDL-P: 1.29 [95% CI: 1.04-1.60]).
Conclusions:
Higher HDL-P was associated with a lower risk of HF. In contrast, larger HDL-size was associated with higher risk of HF and there was no significant association observed between HDL-C and HF risk after accounting for cardiovascular risk factors.
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