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. 2025 Apr;194(2):537-544.
doi: 10.1007/s11845-025-03878-8. Epub 2025 Feb 8.

Clinical, biochemical profile and atherosclerotic cardiovascular risk score (ASCVD) in patients with high HDL cholesterol

Raksha Udupi Mallya  1 , Sudha Vidyasagar  1 , Varashree Bs  2 , Cynthia Amrutha Sukumar  3
Affiliations

Clinical, biochemical profile and atherosclerotic cardiovascular risk score (ASCVD) in patients with high HDL cholesterol

Raksha Udupi Mallya et al. Ir J Med Sci. 2025 Apr.

Abstract

Background: It was observed that many people in the western coastal belt were found to have a high HDL cholesterol, the cause of which was not known. This study was done to learn about the factors contributing to the high HDL cholesterol in these patients and its effect on ASCVD risk.

Methods: In this prospective, case control study, 150 patients were recruited, of which 63 were cases (patients with high HDL cholesterol), and 87 were controls (patients with normal HDL cholesterol). Details regarding their diet, sea-food consumption, habits, comorbidities, daily activity (using GPAQ questionnaire), and blood reports were collected. ASCVD risk score was calculated using an online ASCVD risk estimator. Blood samples of 96 patients (cases 40, controls 56) was tested for cholesterol esterase transfer protein (CETP) levels using ELISA, and the results were compared.

Results: Patients with high HDL cholesterol were found to be physically more active and had median metabolic equivalent (METs) of 4680 (1200, 8580) compared with controls with median METs of 1680 (720, 5580), P-0.013. Cases had a lower mean BMI 23.09(SD-3.69), than in patients with normal HDL cholesterol with a mean of 24.41(SD-4.01), P-0.04. Cases also had a lower triglyceride level (91(69,118) in cases vs 121 (80,151) in controls, P-0.002. Alcohol and sea food consumption had no role on HDL levels in this study. The median CETP level was lower in patients with high HDL levels, 0.336(0.08, 0.336) versus 1.435(0.061, 2.893) in the control group although not statistically significant. Patients with high HDL cholesterol were found to have a significantly lower median 10-year ASCVD risk score 3.05 (0.6, 8.95), compared with patients with normal HDL 6.45 (2.7,14.2).

Conclusion: Patients with high HDL cholesterol were found to be physically more active, had a lower BMI, a lower triglyceride level, and a lower ASCVD risk compared with controls. They also had a lower CETP level. Further research will be required to determine the normal CETP level in Indian population, their genetic makeup, and whether it has a role in cardiovascular protection.

Keywords: ASCVD; CETP; HDL cholesterol; Lipidology; METs.

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Figures

Fig. 1
Fig. 1
Histogram showing the distribution of CETP level in the study population
Fig. 2
Fig. 2
Histogram showing the mean level of CETP in HDL
Fig. 3
Fig. 3
median and IQR of CETP levels in cases and controls
Fig. 4
Fig. 4
Box plot showing the median and IQR of ASCVD risk scores in cases and controls
See this image and copyright information in PMC

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