Abstract 18557: Lipid Phenotypes at the Extremes of HDL Cholesterol: Very Large Database of Lipids Study 9
Background: Patients with extreme levels of HDL-C may inform contemporary controversies in HDL metabolism and therapies.
Aim: To characterize lipid phenotypes at extremes of HDL-C.
Methods: We examined 136,746 U.S. adults and children from the Very Large Database of Lipids (Baltimore, MD; NCT01698489) who were clinically referred for a Vertical Auto Profile test (Birmingham, AL) of cholesterol subfractions from 2009 to 2011. We categorized patients at extreme levels of HDL-C into percentile categories (<0.1th, 0.1th to <1st, 1st to 5th, 95th to 99th, >99th to 99.9th, and >99.9th). Within these groups, we examined HDL-C subclasses 2 and 3, LDL-C, LDL density, non-HDL-C, triglycerides, VLDL-C, and remnant lipoprotein cholesterol.
Results: Patients had a mean age of 59±15 years and 52% were women. With increasing HDL-C percentile, there was monotonically rising HDL2-C/HDL3-C ratio, consistent with more cholesterol loaded HDL particles (Table, P<0.0001). Triglycerides, VLDL-C, and remnant lipoprotein cholesterol levels decreased monotonically with rising HDL-C levels (P<0.0001). LDL-C increased proportionally with VLDL-C decrease resulting in constant median non-HDL-C levels. There is a progressive increase in LDL density with decreasing HDL-C. In addition to these broad trends, there was within-group heterogeneity.
Conclusion: Across a broad range of HDL-C, these findings illustrate the extensive interaction between HDL and triglyceride rich remnant lipoproteins, and LDL density, possibly mediating residual cardiovascular risk. Careful phenotyping will be crucial in selecting clinical trial populations for novel HDL-targeted therapies as patients with low and high HDL-C are not all one in the same.
- © 2013 by American Heart Association, Inc.