Association between changes in high-density lipoprotein cholesterol and risk of cardiovascular disease

The present study was performed to determine the association between changes in the high-density lipoprotein cholesterol (HDL-C) concentration and incident cardiovascular disease (CVD).

Time-dependent Cox regression models were used to evaluate the association between changes in the HDL-C concentration and the risk of incident CVD. Participants were followed up from 2015 to 2021.

In total, 24,123 participants with a median follow-up of 4.26 years were analyzed, and the mean age of the cohort was 56.24 years, 57.8% were female, 24.3% were current smokers, and 12.8% had a history of alcohol use. Low, normal, and high HDL-C was defined as < 40, 40-80, and > 80 mg/dL, respectively. The average time for the two HDL-C measurements was 2.8 years. Compared with participants whose HDL-C was maintained at a normal level, the risk of CVD was higher in those whose HDL-C changed to a low level, remained unchanged at a low level (HR, 1.24; 95% CI, 1.01-1.40, P < 0.001), similarly, the risk of CVD was higher in those whose HDL-C changed from very high level to normal level (HR, 0.81; 95% CI, 0.67-0.99, P = 0.039). Also compared with participants whose HDL-C was maintained at a normal level, the risk of CVD was lower in those whose HDL-C increased from low to normal and high (HR, 0.80; 95% CI, 0.66-0.98, P = 0.029).

Participants whose HDL-C changed to a low level and whose low HDL-C level was maintained had a higher risk of CVD, whereas participants whose HDL-C changed from low to high had a lower risk of CVD.