Very high levels of HDL-C tied to higher mortality risk in CAD patients: JAMA

The key findings of this study were as follows:

1. The study comprised 14 478 people from the UKB and 5467 participants from the EmCAB.

2. A U-shaped connection with outcomes was seen across a median follow-up of 8.9 (IQR, 8.0-9.7) years in the UKB and 6.7 (IQR, 4.0-10.8) years in the EmCAB, with greater risk in those with both low and extremely high HDL-C levels compared to those with intermediate values.

3. After controlling for confounding variables, very high HDL-C levels were linked with a higher risk of all-cause and cardiovascular mortality in the UKB compared to those with HDL-C levels in the range of 40 to 60 mg/dL.

4. These findings were confirmed in the EmCAB.

5. After adjusting for the HDL-C genetic risk score inside the UKB, these correlations remained.

6. Sensitivity studies revealed that men in the UKB had a greater risk of all-cause death in the extremely high HDL-C group than women.

In conclusion, higher HDL-C levels were related to a higher risk of all-cause and cardiovascular death in CAD populations compared to those with normal HDL-C levels, a finding that has previously only been documented in persons without known CAD. These findings have a significant therapeutic impact on risk prediction.

Reference:

Liu C, Dhindsa D, Almuwaqqat Z, et al. Association Between High-Density Lipoprotein Cholesterol Levels and Adverse Cardiovascular Outcomes in High-risk Populations. JAMA Cardiol. Published online May 18, 2022. doi:10.1001/jamacardio.2022.0912