title: Extremely elevated HDL-cholesterol levels are not associated with increased carotid intima-media thickness: data from ELSA Brasil.
abstract: There is evidence that extremely elevated high-density lipoprotein cholesterol (HDL-c), that is, hyperalphalipoproteinemia (HALP) may indicate dysfunctional HDL, conferring increased cardiovascular risk.
  
  
  
  We studied carotid intima-media thickness (cIMT) a marker of subclinical vascular disease according to HDL-c distribution.
  
  
  
  cIMT was studied in subjects with "normal" HDL-c levels (HDL-c 40-50 mg/dL for men; 50-60 mg/dL for women, mean 49.6 ± 5.7 mg/dL, n = 3226); in those with HALP (HDL-c ≥90 mg/dL for both sexes, mean 101.2 ± 10 mg/dL, n = 264) and according to HDL-c quintile distribution (n = 9779). Multiple linear regression was used to test the association of HDL-c and cIMT.
  
  
  
  Subjects with HALP were older (54.5 ± 9.6 vs 51.1 ± 8.8 years, P < .001); more frequently females (86.4% vs 49%, P < .001); and presented a lower burden of risk factors: hypertension (24.6% vs 32.7%, P = .009), diabetes (10.2% vs 20.4%, P < .001), and obesity (18.6% vs 37.6%, P < .001). A similar profile was seen with higher HDL-c quintiles in the whole study population. When compared to normal HDL-c values, HALP was associated with lower maximal cIMT (0.779 ± 0.189 mm vs 0.818 ± 0.200 mm, P = .002), and there was a lower prevalence of individuals with cIMT ≥ 75(th) percentile for age and gender or high cIMT (17.5% vs 26.2%, P = .003). After multivariate analysis, no association was seen between HALP and increasing cIMT values, indeed the 5(th) HDL-c quintile was associated with lower risk of high cIMT (OR = 0.80; 95% CI = 0.68-0.95).
  
  
  
  HALP is associated with lower cIMT and does not indicate a pro-atherogenic phenotype.
authors: Lipid Clinic Heart Institute (InCor) University of Sao Paulo, Medical School Hospital, Sao Paulo, Brazil; Preventive Medicine Center, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
authors: Antonio G
authors: AG
authors: Laurinavicius
authors: Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário, University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors: Itamar S
authors: IS
authors: Santos
authors: Lipid Clinic Heart Institute (InCor) University of Sao Paulo, Medical School Hospital, Sao Paulo, Brazil; Preventive Medicine Center, Hospital Israelita Albert Einstein, Sao Paulo, Brazil. Electronic address: rdsf@uol.com.br.
authors: Raul D
authors: RD
authors: Santos
authors: Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário, University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors: Isabela M
authors: IM
authors: Bensenor
authors: Preventive Medicine Center, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
authors: Raquel D
authors: RD
authors: Conceição
authors: Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário, University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors: Paulo A
authors: PA
authors: Lotufo
mesh_terms: D001938:Brazil; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis; D059168:Carotid Intima-Media Thickness; D008076:Cholesterol, HDL / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D008076:Cholesterol, HDL
keywords: Cardiovascular disease; Carotid intima-media thickness; High density lipoprotein; Hyperalphalipoproteinemia HDL-cholesterol