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Association of HDL cholesterol with all-cause and cardiovascular mortality in primary hypercholesterolemia

Ana M Bea1, Anton González-Guerrero2, Ana Cenarro3

  • 1Hospital Universitario Miguel Servet, IIS Aragón, CIBERCV, Spain.

Atherosclerosis
|October 5, 2024
PubMed

Insights

High high-density lipoprotein cholesterol (HDLc) is linked to lower mortality in individuals with high cholesterol. However, this association disappears when adjusted for cardiovascular risk factors.

Area of Science:

  • Cardiovascular Science
  • Lipid Metabolism
  • Epidemiology

Background:

  • Recent studies indicate a paradoxical increased risk of mortality associated with high high-density lipoprotein cholesterol (HDLc) levels.
  • This challenges the traditional understanding of HDLc as a purely protective factor against cardiovascular disease.

Purpose of the Study:

  • To investigate the association between high-density lipoprotein cholesterol (HDLc) concentration and mortality risk in individuals diagnosed with primary hypercholesterolemia.
  • To determine if elevated HDLc levels are independently linked to all-cause, cardiovascular, or non-cardiovascular mortality in this specific patient group.

Main Methods:

  • A cohort study involving 2992 subjects with primary hypercholesterolemia was conducted.
  • Follow-up duration was 10.2 years, accumulating 30,602 subject-years of data to analyze total, cardiovascular, and non-cardiovascular mortality rates.
  • Subjects were categorized into low, normal, and high HDLc groups for comparative analysis.

Main Results:

  • A total of 168 deaths occurred during the follow-up period.
  • Univariate analysis showed significantly lower mortality in the high HDLc group compared to low and normal HDLc groups (p < 0.001).
  • Cox regression analysis revealed no independent association between HDLc concentration and mortality after adjusting for major cardiovascular risk factors.

Conclusions:

  • While univariate analysis suggested a protective effect of high HDLc against mortality in hypercholesterolemic subjects, this finding did not persist in multivariate analysis.
  • Elevated HDLc levels were not independently associated with total, cardiovascular, or non-cardiovascular mortality when adjusted for key cardiovascular risk factors.
Abstract

Keywords:
Familial hypercholesterolemiaHDL cholesterolPrimary hypercholesterolemiaTotal mortality

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