(12-11-07)Strong inverse link between HDL cholesterol and CV mortality

A large study has highlighted the strong, independent, inverse relationship between HDL cholesterol and cardiovascular mortality.

Specialists at the Adelaide and Meath Hospital in Dublin, Ireland, analysed data from the Systematic Coronary Risk Evaluation (SCORE) database. Information on HDL cholesterol levels was available for 118, 528 people in this database, representing nine European countries (Belgium, Britain, Denmark, Germany, Finland, Italy, Russia, Scotland and Spain) and just over 1 million person-years of follow-up.

In both univariate and multivariate analyses, there was a strong inverse relationship between HDL cholesterol levels and cardiovascular mortality. Overall, the cardiovascular mortality rate was 1.5 times higher in men in the lowest quintile for HDL cholesterol, compared with those in the highest quintile (95% confidence interval 1.4-1.7). The corresponding figure in women was 2.5 (95% confidence interval 1.9-3.3).

In men, each increase of 0.5 mmol/L in HDL cholesterol was associated with a protective 0.76 hazard ratio (95% confidence interval 0.69-0.83) for cardiovascular mortality, after adjusting for confounding factors. In women the protective effect was greater, with a hazard ratio of 0.62 (95% confidence interval 0.54-0.73) for each 0.5 mmol/L increase in HDL cholesterol.

High HDL remained a significant protective factor against cardiovascular mortality even in those over 65 years of age, especially women.

There was also a strong inverse relationship between HDL cholesterol and body mass index (BMI). Subjects in the database who had a BMI of 30 kg/m2had a mean HDL cholesterol level 0.26 mmol/L lower than those who had a BMI of 20 kg/m2.

The researchers concluded: "This study, the largest investigating this relationship to date, shows that low HDL cholesterol is a strong, independent predictor of cardiovascular death, especially in women."

Dr Marie-Therese Cooney, who presented the data during a Young Investigators' Award session at the ESC congress, said the results suggested that including HDL as a specific additional variable in risk scoring systems could improve the accuracy of such risk estimates. This is currently being investigated, she said.

Source: European Society of Cardiology congress, Vienna, Austria, 1-5 September 2007, presentation number 797.

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