Association of high-density lipoprotein cholesterol with coronary heart disease risk across categories of low-density lipoprotein cholesterol: the atherosclerosis risk in communities study.
BACKGROUND
National cholesterol treatment guidelines include a low level of high-density lipoprotein (HDL) cholesterol (<40 mg/dL) as a major risk factor for coronary heart disease (CHD) that should be considered when making decisions on treatment of low-density lipoprotein (LDL) cholesterol.


METHODS
We investigated the association of HDL and LDL-cholesterol with incident CHD events (fatal or nonfatal CHD) over 14 years of follow-up among 13,615 adults aged 45 to 64 years in the Atherosclerosis Risk in Communities study.


RESULTS
A total of 966 (7.1%) participants had a CHD event during follow-up. After adjustment for age, race, sex, diabetes, smoking, alcohol consumption, systolic blood pressure, waist circumference, chronic kidney disease and physical activity, a graded association was present between progressively lower levels of HDL-cholesterol and higher CHD risk, overall (P < 0.001) and within each level of LDL-cholesterol (<100, 100-129, 130-159, 160-189 and ≥190 mg/dL) investigated (all P < 0.05). In addition, after multivariable adjustment including LDL-cholesterol, each standard deviation higher HDL-cholesterol (18 mg/dL) was associated with a hazard ratio of incident CHD of 0.70 (95% CI: 0.63-0.77).


CONCLUSIONS
These data suggest a graded association exists between lower levels of HDL-cholesterol and CHD across the full range of LDL-cholesterol levels. As interventions targeting HDL levels are developed, the combinatorial effects of lower HDL levels with various levels of LDL-cholesterol should be examined.
Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, 35205, USA. pmuntner@uab.edu
Paul
P
Muntner
Fleur
F
Lee
Brad C
BC
Astor
D015415:Biomarkers / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D003327:Coronary Disease / Q000097:blood* / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012111:Residence Characteristics; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
D015415:Biomarkers; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL