Abstract 17332: High-density Lipoprotein Particle Concentration Has a Stronger Inverse Association With Cardiovascular Events Than High-density Lipoprotein Cholesterol in a Coronary Catheterization Population
Background: Though high-density lipoprotein cholesterol (HDL-C) is inversely associated with cardiovascular risk, interventions targeted to increase HDL-C have failed to decrease cardiovascular events, suggesting that beneficial effects of HDL may be unrelated to cholesterol content. We hypothesized that HDL particle number (HDL-P) would more strongly correlate with cardiovascular risk than traditional HDL measurements.
Methods: NMR analysis of lipoprotein particle concentration and size were performed in frozen plasma obtained from 1,736 individuals enrolled in the CATHGEN biorepository of patients undergoing cardiac catheterization at Duke University Hospital. Cox proportional hazards were performed to assess the relations between lipoprotein variables and time to events (death or death/MI). Clinical data were adjusted for age, sex, race, diabetes, hypertension, hyperlipidemia, smoking status and body-mass index. P values were adjusted for multiple comparisons.
Results: Mean HDL-C and HDL-P concentrations were 42 ± 11 mg/dL and 29 ± 7 umol/L, respectively. HDL-P had a strong inverse correlation with time to death (HR 0.931, P=2.48e-24) and death/MI (HR 0.933, P=8.77e-26) that was more pronounced than that of HDL-C (HR 0.982, P=3.40e-5; HR 0.984, P=7.08e-5, respectively). The addition of HDL-C to the model containing HDL-P had minimal effect on the association with incident events. Conversely, addition of HDL-P to the HDL-C model improved the overall fit of the model.
Conclusions: HDL-P had a stronger inverse association with incident cardiovascular events and mortality compared to HDL-C. The predictive value of HDL-P was not significantly moderated or enhanced by HDL-C. HDL-P may therefore serve as a better marker of cardiovascular risk than HDL-C. This finding may have implications for the monitoring of HDL-directed pharmacologic therapies and provides insights into the biology of HDL effects on cardiovascular health, where particle number may be more relevant than cholesterol content, per se. More work is required to assess the relation to other lipoprotein factors.
- © 2013 by American Heart Association, Inc.