Impact of change in high-density lipoprotein cholesterol from baseline on risk for major cardiovascular events.
BACKGROUND
Low concentration of high-density lipoprotein cholesterol (HDL-C) has increasingly been recognized as a strong and independent predictor of cardiovascular risk. The aim of this study was to determine the association between change in HDL-C concentration from baseline and risk of a major cardiovascular event in a commercially insured population cohort with suboptimal HDL-C and low-density lipoprotein cholesterol (LDL-C) concentrations at baseline.


METHODS
A retrospective longitudinal survival analysis was conducted using claims data from a large, commercial US health plan. To be included, patients had to be > or =50 years of age on the index date (laboratory test date between January 1, 2000 and December 31, 2003 on which both their LDL-C and HDL-C were not at goal), be continuously enrolled for a minimum of 6 months prior to and 12 months after the index date, and had to have at least one other laboratory panel result within 1 year prior to the cardiovascular event or study disenrollment. Cox proportional hazards analysis was conducted to assess the association between change in HDL-C concentrations and risk of a major cardiovascular event (defined as a > or =1-day hospitalization for a cardiovascular disease [CVD] diagnosis or an invasive cardiovascular procedure) within 5 years of the index date, after adjusting for covariates.


RESULTS
A 0.026 mmol/L (1 mg/dL) increase in HDL-C from baseline was associated with a statistically significant 1.9% decreased risk of a major cardiovascular event (P<0.0001; hazard ratio: 0.981; 95% CI: 0.974, 0.989), after adjustment for covariates.


CONCLUSIONS
Our finding of an inverse association between change in HDL-C concentrations and risk of a major cardiovascular event confirms previously reported results. Increasing HDL-C concentrations may serve as an effective measure for preventing future cardiovascular events.
Laitinen
David L
DL
Global Health Economics & Outcomes Research, Abbott Laboratories, 200 Abbott Park Road, Abbott Park, IL 60064-6145, USA. dave.laitinen@abbott.com
Manthena
Shivaji
S
D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D008055:Lipids / Q000097:blood; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012959:Socioeconomic Factors
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D008055:Lipids