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. 2022 Oct;79(10):2355-2363.
doi: 10.1161/HYPERTENSIONAHA.122.19912. Epub 2022 Aug 15.

High HDL (High-Density Lipoprotein) Cholesterol Increases Cardiovascular Risk in Hypertensive Patients

Valentina Trimarco  1 , Raffaele Izzo  2 , Carmine Morisco  2   3 , Pasquale Mone  4   5 , Maria Virginia Manzi  2 , Angela Falco  1 , Daniela Pacella  6 , Paola Gallo  2 , Maria Lembo  2 , Gaetano Santulli  2   3   4   7   5 , Bruno Trimarco  2   3
Affiliations

High HDL (High-Density Lipoprotein) Cholesterol Increases Cardiovascular Risk in Hypertensive Patients

Valentina Trimarco et al. Hypertension. 2022 Oct.

Abstract

Background: Emerging evidence suggests that elevated circulating levels of HDL-C (high-density lipoprotein cholesterol) could be linked to an increased mortality risk. However, to the best of our knowledge, the relationship between HDL-C and specific cardiovascular events has never been investigated in patients with hypertension.

Methods: To fill this knowledge gap, we analyzed the relationship between HDL-C levels and cardiovascular events in hypertensive patients within the Campania Salute Network in Southern Italy.

Results: We studied 11 987 patients with hypertension, who were followed for 25 534 person-years. Our population was divided in 3 groups according to the HDL-C plasma levels: HDL-C<40 mg/dL (low HDL-C); HDL-C between 40 and 80 mg/dL (medium HDL-C); and HDL-C>80 mg/dL (high HDL-C). At the follow-up analysis, adjusting for potential confounders, we observed a total of 245 cardiovascular events with a significantly increased risk of cardiovascular events in the low HDL-C group and in the high HDL-C arm compared with the medium HDL-C group. The spline analysis revealed a nonlinear U-shaped association between HDL-C levels and cardiovascular outcomes. Interestingly, the increased cardiovascular risk associated with high HDL-C was not confirmed in female patients.

Conclusions: Our data demonstrate that there is a U-shaped association between HDL-C and the risk of cardiovascular events in male patients with hypertension.

Keywords: cholesterol; dyslipidemias; heart disease risk factors; hydroxymethylglutaryl-CoA reductase inhibitors; hypercholesterolemia; population; sex characteristics.

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Figures

Figure 1.
Figure 1.. Flow chart of the study.
CV indicates cardiovascular; and HDL-C, high-density lipoprotein cholesterol.
Figure 2.
Figure 2.. Cardiovascular risk is increased by both low HDL-C (high-density lipoprotein cholesterol) and high HDL-C.
Risk of cardiovascular (CV) events in our population divided in 3 groups according to the HDL-C levels.
Figure 3.
Figure 3.. A U-shaped association links HDL-C (high-density lipoprotein cholesterol) and the risk of cardiovascular events in patients with hypertension.
Spline plot showing the U-shaped association between HDL-C and risk of cardiovascular events. The shaded area represents the 95% CI. The blue dashed line indicates the HDL-C reference value at 40 mg/dL. HR indicates hazard ratio.
Figure 4.
Figure 4.. Female patients with hypertension do not exhibit a U-shaped association between HDL-C (high-density lipoprotein cholesterol) and the risk of cardiovascular events.
Spline plots showing the association between HDL-C and risk of cardiovascular events in female (A) and male (B) patients with hypertension. The shaded area represents the 95% CI. The blue dashed line indicates the HDL-C reference value at 40 mg/dL. HR indicates hazard ratio.
See this image and copyright information in PMC

References

    1. Wilson PW, Abbott RD, Castelli WP High density lipoprotein cholesterol and mortality. The Framingham Heart Study. Arteriosclerosis. 1988;8:737–741. doi: 10.1161/01.atv.8.6.737 - DOI - PubMed
    1. Pekkanen J, Linn S, Heiss G, Suchindran CM, Leon A, Rifkind BM, Tyroler HA. Ten-year mortality from cardiovascular disease in relation to cholesterol level among men with and without preexisting cardiovascular disease. N Engl J Med. 1990;322:1700–1707. doi: 10.1056/NEJM199006143222403 - DOI - PubMed
    1. Sourlas A, Kosmas CE. Inheritance of high and low HDL: mechanisms and management. Curr Opin Lipidol. 2019;30:307–313. doi: 10.1097/MOL.0000000000000610 - DOI - PubMed
    1. Casula M, Colpani O, Xie S, Catapano AL, Baragetti A. HDL in atherosclerotic cardiovascular disease: in search of a role. Cells. 2021;10:1869. doi: 10.3390/cells10081869 - DOI - PMC - PubMed
    1. Gordon DJ, Probstfield JL, Garrison RJ, Neaton JD, Castelli WP, Knoke JD, Jacobs DR Jr, Bangdiwala S, Tyroler HA. High-density lipoprotein cholesterol and cardiovascular disease. Four prospective American studies. Circulation. 1989;79:8–15. doi: 10.1161/01.cir.79.1.8 - DOI - PubMed

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