title: Isolated low levels of high-density lipoprotein cholesterol are associated with an increased risk of coronary heart disease: an individual participant data meta-analysis of 23 studies in the Asia-Pacific region.
abstract: BACKGROUND
  Previous studies have suggested that there is a novel dyslipidemic profile consisting of isolated low high-density lipoprotein cholesterol (HDL-C) level that is associated with increased risk of coronary heart disease, and that this trait may be especially prevalent in Asian populations.
  
  
  RESULTS
  Individual participant data from 220 060 participants (87% Asian) in 37 studies from the Asia-Pacific region were included. Low HDL-C (HDL <1.03 mmol/L in men and <1.30 mmol/L in women) was seen among 33.1% (95% confidence interval [CI], 32.9-33.3) of Asians versus 27.0% (95% CI, 26.5-27.5) of non-Asians (P<0.001). The prevalence of low HDL-C in the absence of other lipid abnormalities (isolated low HDL-C) was higher in Asians compared with non-Asians: 22.4% (95% CI, 22.2-22.5) versus 14.5% (95% CI, 14.1-14.9), respectively (P<0.001). During 6.8 years of follow-up, there were 574 coronary heart disease and 739 stroke events. There was an inverse relationship between low HDL-C with coronary heart disease in all individuals (hazard ratio, 1.57; 95% CI, 1.31-1.87). In Asians, isolated low levels of HDL-C were as strongly associated with coronary heart disease risk as low levels of HDL-C combined with other lipid abnormalities (hazard ratio, 1.67 [95% CI, 1.27-2.19] versus 1.63 [95% CI, 1.24-2.15], respectively). There was no association between low HDL-C and stroke risk in this population (hazard ratio, 0.95 [95% CI, 0.78 to 1.17] with nonisolated low HDL-C and 0.81 [95% CI, 0.67-1.00] with isolated low HDL-C).
  
  
  CONCLUSIONS
  Isolated low HDL-C is a novel lipid phenotype that appears to be more prevalent among Asian populations, in whom it is associated with increased coronary risk. Further investigation into this type of dyslipidemia is warranted.
authors: Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 S Second Street, Minneapolis, MN 55454, USA. rhuxley@umn.edu
authors: Rachel R
authors: RR
authors: Huxley
authors: Federica
authors: F
authors: Barzi
authors: Tai Hing
authors: TH
authors: Lam
authors: Sebastien
authors: S
authors: Czernichow
authors: Xianghua
authors: X
authors: Fang
authors: Tim
authors: T
authors: Welborn
authors: Jonathan
authors: J
authors: Shaw
authors: Hirotsugu
authors: H
authors: Ueshima
authors: Paul
authors: P
authors: Zimmet
authors: Sun Ha
authors: SH
authors: Jee
authors: Jeetesh V
authors: JV
authors: Patel
authors: Ian
authors: I
authors: Caterson
authors: Vlado
authors: V
authors: Perkovic
authors: Mark
authors: M
authors: Woodward
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D044362:Australasia / Q000453:epidemiology; D008076:Cholesterol, HDL / Q000097:blood*; D003327:Coronary Disease / Q000097:blood* / Q000208:ethnology*; D050171:Dyslipidemias / Q000097:blood* / Q000208:ethnology*; D005202:Asia, Eastern / Q000453:epidemiology; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000208:ethnology; D015995:Prevalence; D012307:Risk Factors
chemical_list: D008076:Cholesterol, HDL