title: Impact of inflammatory biomarkers on relation of high density lipoprotein-cholesterol with incident coronary heart disease: cardiovascular Health Study.
abstract: BACKGROUND
  Inflammatory factors and low HDL-C relate to CHD risk, but whether inflammation attenuates any protective association of high HDL-C is unknown.
  
  
  OBJECTIVE
  Investigate inflammatory markers' individual and collective impact on the association of HDL-C with incident coronary heart disease (CHD).
  
  
  METHODS
  In 3888 older adults without known cardiovascular disease (CVD), we examined if the inflammatory markers C-reactive protein (CRP), interleukin-6 (IL-6), and lipoprotein-associated phospholipase A2 (Lp-PLA₂) modify the relation of HDL-C with CHD. HDL-C, CRP, IL-6, and Lp-PLA₂ values were grouped as using gender-specific tertiles. Also, an inflammation index of z-score sums for CRP, IL-6, and Lp-PLA₂ was categorized into tertiles. We calculated CHD incidence for each HDL-C/inflammation group and performed Cox regression, adjusted for standard CVD risk factors and triglycerides to examine the relationship of combined HDL-C-inflammation groups with incident events.
  
  
  RESULTS
  CHD incidence (per 1000 person years) was higher for higher levels of CRP, IL-6, and the index, and lower for higher levels of HDL-C. Compared to high HDL-C/low-inflammation categories (referent), adjusted HRs for incident CHD were increased for those with high HDL-C and high CRP (HR = 1.50, p < 0.01) or highest IL-6 tertile (HR = 1.40, p < 0.05), but not with highest Lp-PLA₂ tertile. Higher CHD incidence was similarly seen for those with intermediate or low HDL-C accompanied by high CRP, high IL-6, or a high inflammatory index.
  
  
  CONCLUSIONS
  The protective relation of high HDL-C for incident CHD appears to be attenuated by greater inflammation.
authors.affiliation: Heart Disease Prevention Program, Division of Cardiology, University of California Irvine School of Medicine, Irvine, CA, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Tehrani
authors.forename: Julius M
authors.initials: JM
authors.lastname: Gardin
authors.forename: David
authors.initials: D
authors.lastname: Yanez
authors.forename: Calvin H
authors.initials: CH
authors.lastname: Hirsch
authors.forename: Donald M
authors.initials: DM
authors.lastname: Lloyd-Jones
authors.forename: Phyllis K
authors.initials: PK
authors.lastname: Stein
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Wong
mesh_terms: D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase / Q000097:blood; D001741:Black or African American; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology; D008076:Cholesterol, HDL / Q000097:blood*; D003327:Coronary Disease / Q000097:blood* / Q000453:epidemiology / Q000208:ethnology; D005260:Female; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D044465:White People
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL; D015850:Interleukin-6; D002097:C-Reactive Protein; D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase
keywords: C-reactive protein; Coronary heart disease; High density lipoprotein; Inflammation