High and low HDL-C increases risk of CV events among men with hypertension

Italy: A new study conducted by Valentina Trimarco and colleagues showed that HDL-C (high-density lipoprotein cholesterol) and the risk of cardiovascular events in male hypertensive patients are related. The findings of this study were published in Hypertension.

High levels of HDL-C may be associated with a higher risk of death, according to recent research. To the best of our knowledge, no research has ever been done on individuals with hypertension on the association between HDL-C and certain cardiovascular events. Therefore, the purpose of this study was to describe the part HDL-C plays in all types of cardiovascular events.

Researchers examined the connection between HDL-C levels and cardiovascular events in hypertensive individuals within the Campania Salute Network in Southern Italy to close this knowledge gap.

The key findings of this study were:

1. During a 25 534 person-year period, 11 987 people with hypertension were identified and monitored.

2. According to the plasma HDL-C levels, the population was split into three groups: low HDL-C (HDL-C<40 mg/dL), medium HDL-C (HDL-C between 40 and 80 mg/dL), and high HDL-C (HDL-C >80 mg/dL) (high HDL-C).

3. A total of 245 cardiovascular events were noted at the follow-up analysis after possible confounders were taken into account, with the low HDL-C group and the high HDL-C arm having a considerably higher risk of cardiovascular events than the medium HDL-C group.

4. A nonlinear U-shaped connection between HDL-C levels and cardiovascular outcomes was found by the spline analysis. It's interesting to note that female patients did not experience the elevated cardiovascular risk linked with high HDL-C.

In conclusion, the findings of this study fill a critical knowledge gap in the field: HDL-C levels are currently taken into account as a protective factor in algorithms used to estimate cardiovascular risk in the general population, but at very high levels, this protective effect does not appear to hold true and may even increase risk. In female subjects, the increased cardiovascular risk linked to high HDL-C levels was not confirmed. Notably, one should take into account the low number of occurrences, which results in less accurate estimations when compared to the whole cohort (particularly in the female cohort).

Reference: 

Trimarco, V., Izzo, R., Morisco, C., Mone, P., Maria Virginia, M., Falco, A., Pacella, D., Gallo, P., Lembo, M., Santulli, G., & Trimarco, B. (2022). High HDL (high-density lipoprotein) cholesterol increases cardiovascular risk in hypertensive patients. Hypertension.https://doi.org/10.1161/HYPERTENSIONAHA.122.19912