title: Lipid phenotypes at the extremes of high-density lipoprotein cholesterol: The very large database of lipids-9.
abstract: BACKGROUND
  Low serum levels of high-density lipoprotein cholesterol (HDL-C) are an important risk factor for atherosclerotic disease. To date, therapeutically raising HDL-C has not been shown to impact risk for cardiovascular events.
  
  
  OBJECTIVE
  We aim to characterize lipid parameters at the extremes of HDL-C.
  
  
  METHODS
  We examined cholesterol profiles from 1,350,908 US adults and children from the Very Large Database of Lipids who were clinically referred for advanced lipoprotein testing from 2009 to 2011. We categorized patients into HDL-C percentile categories (<0.1th, 0.1th-<1st, 1st-5th, 25th-75th, 95th-99th, >99th-99.9th, and >99.9th). Within these groups, we examined HDL-C subclasses, low-density lipoprotein cholesterol (LDL-C), LDL and very-low density lipoprotein densities, non-HDL-C, triglycerides (TG), very-low density lipoprotein cholesterol, and remnant lipoprotein cholesterol (RLP-C), as well as prevalence of Fredrickson-Levy dyslipidemias.
  
  
  RESULTS
  Extremely low HDL-C percentiles were associated with increased LDL density, TG, and especially RLP-C. Very high HDL-C levels (≥ 92 mg/dL) showed increasing HDL2-C/HDL3-C ratio and very low levels of RLP-C and triglyceride-rich lipoproteins. Type IV dyslipidemia had the highest prevalence among classical dyslipidemia and was the most frequent at extremely low HDL-C percentiles.
  
  
  CONCLUSIONS
  These findings demonstrate a high prevalence of elevated triglyceride-rich lipoprotein levels and increased LDL density in patients with extremely low HDL-C levels. The relative contributions of these various changes in lipid profiles of patients with low HDL-C to cardiovascular risk need to be further scrutinized to more fully establish if low HDL-C is truly an independent risk factor for coronary heart disease or simply reflects detrimental shifts in the levels of atherogenic lipoproteins.
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA. Electronic address: jquispe1@jhmi.edu.
authors.forename: Renato
authors.initials: R
authors.lastname: Quispe
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Hijji
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
authors.forename: Kristopher J
authors.initials: KJ
authors.lastname: Swiger
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
authors.forename: Seth S
authors.initials: SS
authors.lastname: Martin
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Mohamed B
authors.initials: MB
authors.lastname: Elshazly
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
authors.forename: Parag H
authors.initials: PH
authors.lastname: Joshi
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.affiliation: Department of Medicine, Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Center, Quebec, Canada.
authors.forename: Allan D
authors.initials: AD
authors.lastname: Sniderman
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, USA; University of Illinois College of Medicine, Peoria, IL, USA.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Toth
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Jones
mesh_terms: D002318:Cardiovascular Diseases / Q000097:blood* / Q000453:epidemiology / Q000473:pathology; D008076:Cholesterol, HDL / Q000097:blood*; D016208:Databases, Factual; D050171:Dyslipidemias / Q000097:blood* / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D014481:United States
chemical_list: D008076:Cholesterol, HDL; D014280:Triglycerides
keywords: Cardiovascular diseases; Dyslipidemia; High-density lipoprotein cholesterol; Lipids; Prevention