title: Triglyceride and HDL-C Dyslipidemia and Risks of Coronary Heart Disease and Ischemic Stroke by Glycemic Dysregulation Status: The Strong Heart Study.
abstract: High triglyceride (TG) levels and low HDL cholesterol (HDL-C) levels are risk factors for cardiovascular disease. It is unclear whether this relationship depends on glycemic dysregulation, sex, or LDL cholesterol (LDL-C) level.
  
  
  
  We studied 3,216 participants (40% men, 41% with diabetes) who were free of cardiovascular disease at baseline in a community-based, prospective cohort of American Indians (median follow-up 17.7 years). Cox models estimated hazard ratios (HRs) and 95% CIs for incident ischemic stroke and coronary heart disease (CHD) in relation to combined TG and HDL-C status, where a fasting TG level ≥150 mg/dL was "high" and a fasting HDL-C level <40 mg/dL for men (<50 mg/dL for women) was "low." Models included age, sex, BMI, smoking, diabetes, fasting LDL-C level, antihypertensive medications, physical activity, estimated glomerular filtration rate, and urinary albumin-to-creatinine ratio.
  
  
  
  Participants with high TG and low HDL levels had a 1.32-fold greater HR (95% CI 1.06-1.64) for CHD than those with normal TG and normal HDL levels. It was observed in participants with diabetes, but not in those without diabetes, that high TG plus low HDL levels were associated with a 1.54-fold greater HR (95% CI 1.15-2.06) for CHD (Pvalue for interaction = 0.003) and a 2.13-fold greater HR (95% CI 1.06-4.29) for stroke (Pvalue for interaction = 0.060). High TG and low HDL level was associated with CHD risk in participants with an LDL-C level of ≥130 mg/dL, but this was not observed in those participants with lower LDL-C levels. Sex did not appear to modify these associations.
  
  
  
  Adults with both high TG and low HDL-C, particularly those with diabetes, have increased risks of incident CHD and stroke. In particular, those with an LDL-C level ≥130 mg/dL may have an increased risk of incident stroke.
authors.affiliation: Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine and (by courtesy) Division of Epidemiology, Department of Health Research & Policy, Stanford University Medical Center, Stanford, CA jennifer.s.lee@stanford.edu.|Medical Services, VA Palo Alto Health Care System, Palo Alto, CA.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine and (by courtesy) Division of Epidemiology, Department of Health Research & Policy, Stanford University Medical Center, Stanford, CA.
authors.forename: Po-Yin
authors.initials: PY
authors.lastname: Chang
authors.affiliation: Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Division of Cardiology, Department of Medicine, and Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Jorge R
authors.initials: JR
authors.lastname: Kizer
authors.affiliation: Missouri Breaks Industries Research, Inc., Timber Lake, SD.
authors.forename: Lyle G
authors.initials: LG
authors.lastname: Best
authors.affiliation: MedStar Health Research Institute, Washington, DC.
authors.forename: Barbara V
authors.initials: BV
authors.lastname: Howard
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D003324:Coronary Artery Disease / Q000097:blood* / Q000209:etiology; D003920:Diabetes Mellitus / Q000097:blood*; D050171:Dyslipidemias / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000209:etiology; D014280:Triglycerides / Q000097:blood*
chemical_list: D001786:Blood Glucose; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D014280:Triglycerides