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Low plasma HDL-c, a vascular risk factor in high risk patients independent of LDL-c.
Eur J Clin Invest. 2009 Aug; 39(8):680-8.EJ

Abstract

BACKGROUND

High concentrations of high density lipoprotein-cholesterol (HDL-c) are associated with lower cardiovascular risk, but it is not known whether this is also the case in the presence of intensive low density lipoprotein-cholesterol (LDL-C) therapy. In this study, we determined the relationship between HDL-c and new non-fatal or fatal vascular events in patients with various manifestations of clinical evident vascular disease and evaluated whether this relationship is modified by LDL-c levels.

MATERIALS AND METHODS

Prospective single centre, cohort study of 3837 patients with a history or recent diagnosis of clinical manifest vascular disease (coronary, cerebrovascular, peripheral arterial disease or abdominal aortic aneurysm) The relationship between HDL-c quintiles and time to a new event (myocardial infarction, ischaemic stroke, vascular death) was quantified with Cox-regression models and adjusted for potential confounders (age, gender, body mass index, type 2 diabetes, triglycerides, smoking, use of alcohol and lipid-lowering therapy). Effect modification of LDL-c was assessed with interaction terms.

RESULTS

During a median follow up of 3.3 (range 0.1-9.5) years, a total of 465 first new events occurred. Compared with the lowest quintile, the upper quintile of HDL-c levels was associated with a lower risk for new events; Hazard Ratio 0.61 (95% CI 0.43-0.86) irrespective of the localisation of vascular disease and use of lipid-lowering medication. Higher HDL-c levels were associated with comparably lower risks for vascular events in patients with LDL-c levels above and below 2.5 mmol L(-1) (P-values for interaction > 0.05).

CONCLUSIONS

Patients with various clinical manifestations of vascular diseases in the highest HDL-c quintile have a lower risk for vascular events compared with patients in the lowest HDL-c quintile. Further, the current results expand the evidence by showing that also in a cohort of patients with various localisations of clinical evident vascular disease, in which statins were widely used, higher HDL-c levels confer a lower risk for developing new vascular events, irrespective of the localisation of vascular disease, use of lipid-lowering medication and plasma LDL-c concentration.

Authors+Show Affiliations

Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19453647

Citation

Hajer, G R., et al. "Low Plasma HDL-c, a Vascular Risk Factor in High Risk Patients Independent of LDL-c." European Journal of Clinical Investigation, vol. 39, no. 8, 2009, pp. 680-8.
Hajer GR, van der Graaf Y, Bots ML, et al. Low plasma HDL-c, a vascular risk factor in high risk patients independent of LDL-c. Eur J Clin Invest. 2009;39(8):680-8.
Hajer, G. R., van der Graaf, Y., Bots, M. L., Algra, A., & Visseren, F. L. (2009). Low plasma HDL-c, a vascular risk factor in high risk patients independent of LDL-c. European Journal of Clinical Investigation, 39(8), 680-8. https://doi.org/10.1111/j.1365-2362.2009.02155.x
Hajer GR, et al. Low Plasma HDL-c, a Vascular Risk Factor in High Risk Patients Independent of LDL-c. Eur J Clin Invest. 2009;39(8):680-8. PubMed PMID: 19453647.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Low plasma HDL-c, a vascular risk factor in high risk patients independent of LDL-c. AU - Hajer,G R, AU - van der Graaf,Y, AU - Bots,M L, AU - Algra,A, AU - Visseren,F L J, AU - ,, Y1 - 2009/05/12/ PY - 2009/5/21/entrez PY - 2009/5/21/pubmed PY - 2009/12/16/medline SP - 680 EP - 8 JF - European journal of clinical investigation JO - Eur. J. Clin. Invest. VL - 39 IS - 8 N2 - BACKGROUND: High concentrations of high density lipoprotein-cholesterol (HDL-c) are associated with lower cardiovascular risk, but it is not known whether this is also the case in the presence of intensive low density lipoprotein-cholesterol (LDL-C) therapy. In this study, we determined the relationship between HDL-c and new non-fatal or fatal vascular events in patients with various manifestations of clinical evident vascular disease and evaluated whether this relationship is modified by LDL-c levels. MATERIALS AND METHODS: Prospective single centre, cohort study of 3837 patients with a history or recent diagnosis of clinical manifest vascular disease (coronary, cerebrovascular, peripheral arterial disease or abdominal aortic aneurysm) The relationship between HDL-c quintiles and time to a new event (myocardial infarction, ischaemic stroke, vascular death) was quantified with Cox-regression models and adjusted for potential confounders (age, gender, body mass index, type 2 diabetes, triglycerides, smoking, use of alcohol and lipid-lowering therapy). Effect modification of LDL-c was assessed with interaction terms. RESULTS: During a median follow up of 3.3 (range 0.1-9.5) years, a total of 465 first new events occurred. Compared with the lowest quintile, the upper quintile of HDL-c levels was associated with a lower risk for new events; Hazard Ratio 0.61 (95% CI 0.43-0.86) irrespective of the localisation of vascular disease and use of lipid-lowering medication. Higher HDL-c levels were associated with comparably lower risks for vascular events in patients with LDL-c levels above and below 2.5 mmol L(-1) (P-values for interaction > 0.05). CONCLUSIONS: Patients with various clinical manifestations of vascular diseases in the highest HDL-c quintile have a lower risk for vascular events compared with patients in the lowest HDL-c quintile. Further, the current results expand the evidence by showing that also in a cohort of patients with various localisations of clinical evident vascular disease, in which statins were widely used, higher HDL-c levels confer a lower risk for developing new vascular events, irrespective of the localisation of vascular disease, use of lipid-lowering medication and plasma LDL-c concentration. SN - 1365-2362 UR - https://www.unboundmedicine.com/medline/citation/19453647/Low_plasma_HDL_c_a_vascular_risk_factor_in_high_risk_patients_independent_of_LDL_c_ L2 - https://doi.org/10.1111/j.1365-2362.2009.02155.x DB - PRIME DP - Unbound Medicine ER -