Clinical Significance of High-Density Lipoprotein Cholesterol in Patients With Low Low-Density Lipoprotein Cholesterol
Emil M. deGoma, MD*,*,
Nicholas J. Leeper, MD* and
Paul A. Heidenreich, MD, MS*,
* Department of Cardiology, Stanford University Hospital, Stanford, California
Department of Cardiology, Veterans Administration Palo Alto Health Care System, Palo Alto, California.
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Figure 1 Unadjusted Rates of the Combined Primary End Point
Unadjusted rates of myocardial injury or ischemic heart disease (IHD) hospitalization (n = 3,982) and the secondary end point, all-cause mortality (n = 4,188), at 1 year after the index low-density lipoprotein cholesterol date are shown. In univariate analysis, an inverse relationship was shown between high-density lipoprotein cholesterol (HDL-C) and admission for IHD, whereas a U-shaped relationship was observed between HDL-C and the risk of overall mortality at 1 year. p = 0.001 for myocardial injury or IHD hospitalization; p = 0.01 for total mortality. Q1 to Q4 = HDL-C quartiles 1 to 4.
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Figure 2 Adjusted Odds Ratios for the Combined Primary End Point
Adjusted odds ratios of myocardial injury or ischemic heart disease (IHD) admission (n = 3,884) and the secondary end point, death from any cause (n = 4,070), at 1 year after the index low-density lipoprotein cholesterol date are shown. In multivariate-adjusted analysis using the highest high-density lipoprotein cholesterol (HDL-C) quartile (Q4) as the reference quartile, an inverse relationship was shown between HDL-C and admission for IHD, whereas a U-shaped relationship was observed between HDL-C and the risk of overall mortality at 1 year. The p values for myocardial injury or IHD admission: 0.04 HDL-C categoric, 0.007 HDL-C continuous. The p values for total mortality: 0.18 HDL-C categoric, 0.001 for separate linear relationships above and below HDL-C of 43 mg/dl.
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Figure 3 Risk Ratios for Death From Any Cause
In multivariable analysis adjusted for demographics, medical history, laboratory values, and medication use, analysis of the odds ratios for death from any cause using the highest high-density lipoprotein cholesterol (HDL-C) quartile (Q4) as the reference quartile revealed a U-shaped curve, with the highest risk of mortality observed in the lowest and highest quartiles, similar to findings observed in earlier epidemiologic studies. *Adjusted for age, diastolic blood pressure, and cigarettes/day. Not adjusted.  Adjusted for age, mean daily alcohol consumption, body mass index, education, physical activity, cigarettes/day, systolic blood pressure, and total cholesterol.  Adjusted for age. ||Adjusted for age, gender, ischemic heart disease, stroke, peripheral arterial disease, congestive heart failure, diabetes, hypertension, malignancy, chronic obstructive pulmonary disease, liver disease, alcohol dependence or abuse, statin use, fibrate use, creatinine, hemoglobin A1c, troponin, hemoglobin, low-density lipoprotein cholesterol, aspartate aminotransferase, and triglycerides. PAVA = Palo Alto Veterans Administration (present study). Q1 to Q4 = HDL-C quartiles 1 to 4; Q1 to Q5 = HDL-C quintiles 1 to 5; S1 to S6 = HDL-C sextiles 1 to 6; T1 to T3 = HDL-C tertiles 1 to 3.
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