Abstract P218: Extremely Elevated HDL-Cholesterol Levels Are Independently Associated With Lower Carotid Intima-Media Thickness: Data From the ELSA-Brasil
Introduction: HDL-cholesterol (HDL-c) is a strong, traditional negative cardiovascular (CV) risk factor. However, some reports suggest that extremely elevated HDL-c, i.e. hyperalphalipoproteinemia (HALP), may mark dysfunctional HDL particles, paradoxically conferring increased CV risk. Moreover, therapies aimed to increase HDL-c levels through CETP inhibition failed to demonstrate CV risk reduction despite substantial increase in HDL-c. Carotid Intima-Media Thickness (cIMT) is a reliable surrogate for atherosclerotic disease, validated for CV risk assessment. We studied cIMT among individuals with HALP.
Hypothesis: We assessed the hypothesis that HALP is independently associated with lower cIMT when compared with HDL-c levels on usual normal range.
Methods: The Brazilian Longitudinal Study for Adult Health (ELSA-Brasil) enrolled 15,105 subjects aged 35-74 years between 2008-10 for long-term follow-up, which included IMT measurements in both common carotid arteries and assessment of lipid profile. Two groups were considered for the present analysis: those with “normal” HDL-c levels (HDL-c 40-50mg/dL for men; 50-60mg/dL for women) and those with HALP (HDL-c ≥90mg/dL for both men and women). We assessed and compared the cardiometabolic profile of both populations and its association with cIMT. We used multiple linear regression to study the association between HALP and cIMT.
Results: Overall, 3,372 individuals with “normal” HDL-c levels (mean 49.6 ± 5.7mg/dL) and 272 with HALP (mean 101.2 ± 10mg/dL) were considered. Subjects with HALP were older (54.6±9.5 vs 51.5±9 y, p<0.001); more frequently of female sex (86.0% vs 49.5%, p<0.001); and presented a lower burden of cardiovascular risk factors, including hypertension (26.1% vs 34.4%, p=0.007), diabetes (10.7% vs 21.3%, p<0.001), and abdominal obesity (19.1% vs 37.9%, p<0.001) than those with “normal” HDL-c levels. They also presented slightly but significantly lower LDL-c levels (127±36 vs 131±33mg/dL, p=0.011). HALP was associated with lower maximal cIMT (0.780±0.188mm vs 0.825±0.207mm, p<0.001), retaining statistical significance (p=0.046) even after adjustment for age, sex, race, body mass index, physical activity, use of cholesterol-lowering drugs, and the presence of hypertension, diabetes and smoking.
Conclusion: HALP is independently associated with lower cIMT and seems to confer additional CV protection when compared with HDL-c levels on the usual normal range. These findings do not support the identification of HALP as a proatherogenic phenotype.
Author Disclosures: A.G. Laurinavicius: None. I.S. Santos: None. R.D. Santos: None. I.M. Bonsenor: None. P.A. Lotufo: None.
- © 2015 by American Heart Association, Inc.