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HDL relationship with CV risk uncertain
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HDL is unlikely to represent a CV-specific risk factor because high levels are associated with non-CV outcomes and low levels are tied to other CV risk factors, new data show.
“For the past several decades, it has been widely accepted that HDL cholesterol plays an important role in the development of [CV] mortality and morbidity. Early epidemiological studies consistently demonstrated a linear inverse relationship between HDL levels and CV events,” Dennis T. Ko, MD, MSc, of the Schulich Heart Centre in Toronto, and colleagues wrote. “However, the inability of recent randomized trials to improve clinical outcomes by attempting to increase HDL level has challenged this conventional wisdom.”
The researchers used data from the CANHEART cohort in Ontario, Canada and analyzed individuals without previous CV conditions or severe comorbidities aged 40 to 105 years (n = 631,762; mean age, 57 years; 55.4% women; mean HDL level, 55.2 mg/dL). There were 17,952 deaths during the mean follow-up of 4.9 years. The primary outcome was cause-specific mortality.
The overall rate of all-cause mortality in men was 8.1 per 1,000 person-years. In women, it was 6.6 per 1,000 person-years.
Low HDL, high risk
Ko and colleagues found that individuals with lower HDL levels were associated with higher risk for CV, cancer and other mortality compared to those with reference levels of HDL (men, 41 mg/dL to 50 mg/dL; women, 51 mg/dL to 60 mg/dL). They found men with HDL 30 mg/dL had increased risk for CV mortality (HR = 1.81; 95% CI, 1.45-2.25), cancer mortality (HR = 1.61; 95% CI, 1.32-1.97) and other mortality (HR = 2.01; 95% CI, 1.63-2.47) compared with men with HDL in the reference range, and the same was true for women with HDL 30 mg/dL vs. women with HDL in the reference range (HR for CV mortality = 2.26; 95% CI, 1.56-3.29; HR for cancer mortality = 1.96; 95% CI, 1.43-2.69; HR for other mortality = 2.86; 95% CI, 2.17-3.76).
Those with lower HDL were also more likely to have low incomes, unhealthy lifestyles and higher triglyceride levels, as well as other risk factors and comorbidities.
Individuals with high levels of HDL (> 70 mg/dL in men; > 90 mg/dL in women) were at an increased risk for non-CV mortality.
Focus on lifestyle
The researchers concluded that HDL is unlikely to represent a CV-specific risk factor or target for intervention given the associations with non-CV mortality.
“The link between good cholesterol and heart disease is complex, but it seems certain that there is a connection between people with low good cholesterol levels and other well-known risk factors for heart disease such as poor diet and exercise habits and other medical conditions,” Ko said in a press release. “Focusing on raising HDL is likely not going to help these patients, but these findings show that one of the best interventions in treating and preventing heart disease continues to be lifestyle changes.” – by Cassie Homer
Disclosure: The researchers report no relevant financial disclosures.
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