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HDL Cholesterol Is Remarkably Cardioprotective Against Coronary Artery Disease in Native Hawaiians and Pacific

Austin Szatrowski1, Zane Maggio2, Bohdan Khomtchouk3

  • 1The College of the University of Chicago, Chicago, Illinois, USA.

JACC. Advances
|May 4, 2025
PubMed

Insights

High-density lipoprotein cholesterol (HDL-C) offers greater protection against coronary artery disease (CAD) in Native Hawaiian and Pacific Islanders (NHPIs). This highlights the need for personalized cardiometabolic risk assessments in NHPI populations.

Area of Science:

  • Cardiovascular epidemiology
  • Metabolic disease research
  • Population health disparities

Background:

  • High-density lipoprotein cholesterol (HDL-C) is inversely associated with cardiometabolic risk, with nonlinear effects at extreme levels.
  • Cardiometabolic diseases pose a significant health burden, disproportionately affecting Native Hawaiian and Pacific Islander (NHPI) populations.

Purpose of the Study:

  • To characterize the association of HDL-C with coronary artery disease (CAD), major adverse cardiovascular events (MACE), and type 2 diabetes (T2D) in NHPIs.
  • To compare these associations in NHPIs versus the general population.

Main Methods:

  • Utilized electronic health record data from the NIH All of Us Research Program.
  • Employed Cox proportional hazards models and restricted cubic splines to analyze data from 261 NHPIs and 188,802 individuals in the general cohort.
  • Adjusted for key confounders to assess nonlinear risk dynamics.

Main Results:

  • HDL-C demonstrated a stronger association with reduced CAD risk in NHPIs (HR: 0.32) compared to the general cohort (HR: 0.57).
  • A marginally stronger association was observed for MACE in NHPIs (HR: 0.40) versus the general cohort (HR: 0.54).
  • Type 2 diabetes (T2D) associations were similar between groups, with low HDL-C increasing risk for both CAD and T2D in NHPIs.

Conclusions:

  • The protective effect of HDL-C against cardiometabolic diseases, especially CAD, is more pronounced in NHPIs.
  • Findings suggest the need for tailored clinical assessments and interventions for cardiometabolic health in NHPI populations.
Abstract

Keywords:
Native Hawaiians and Pacific Islanderscardioinformaticscoronary artery diseasehigh-density lipoproteinrisk prediction

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