Abstract 19188: Association of High-Density Lipoprotein Cholesterol With Non-Fatal Cardiac and Non-Cardiac Events: A CANHEART Primary Prevention Sub-Study
Background: Emerging evidence has questioned the role of high-density lipoprotein cholesterol (HDL-C) as an independent risk factor for cardiovascular disease. We sought to understand the relationship between HDL-C and non-fatal clinical outcomes in a primary prevention cohort.
Methods: Patients without prior cardiovascular disease or cancer were identified using the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) cohort, a large primary prevention “big data” database in Ontario, Canada created through linkages of multiple clinical and administrative datasets. Our study cohort consisted of all patients with a lipid profile performed within 1 year prior to January 1st 2008. Outcomes of interest were classified as non-fatal cardiovascular (myocardial infarction/angina, stroke, cardiac arrest), cancer (breast/lung/colorectal/ prostate) and infectious (sepsis and pneumonia). Patients were followed until December 31st, 2012. HDL-C was divided into eight categories starting at less than or equal to 30 mg/dL, in increments of 10mg/dL, to greater than 90 mg/dL. Multivariable cause-specific Cox-proportional hazards models were created, accounting for the competing risk of death to evaluate the relationship between HDL-C with each non-fatal outcome category. The reference group for both women and men was 51 to 60 mg/dl and all analyses were stratified by sex.
Results: In our cohort of 631,762 patients, there was a consistent inverse relationship, with higher adjusted hazard ratios for cardiovascular outcomes in the lower HDL-C strata in both women (2.10 and 0.87 for the <30 and >90 mg/dL categories) and men (2.02 and 0.73 for the <30 and >90 mg/dL categories). A similar relationship was seen for the cancer and infectious outcomes. In women, the hazard ratio for the composite cancer and infectious outcomes ranged from 1.86 in the <30 mg/dL category, to 0.81 in the >90 mg/dL category. For men, the hazard ratio for this composite were 1.84 in the <30 mg/dL category and 1.07 in the >90 mg/dL category.
Conclusions: We found an inverse relationship between HDL-C and cardiovascular, cancer and infectious non-fatal outcomes, suggesting that HDL-C is not a specific predictor of cardiovascular outcomes, but rather a marker of poor overall health.
Author Disclosures: H.C. Wijeysundera: None. M. Koh: None. H. Guo: None. G. Lau: None. D.A. Alter: None. P.C. Austin: None. C.A. Jackevicius: None. J.V. Tu: None. D.T. Ko: None.
- © 2016 by American Heart Association, Inc.