Association between very high HDL-C levels and mortality: A systematic review and meta-analysis

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Journal of clinical lipidology Pub Date : 2024-09-01 DOI:10.1016/j.jacl.2024.06.002

Isadora Mamede , Marcelo Antonio Pinheiro Braga , Otavio C. Martins , Anne E.O. Franchini MD , Rodrigo B. Silveira Filho , Marcel C.F. Santos MD

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引用次数: 0

Abstract

BACKGROUND

Recent research has raised questions about the assumed cardiovascular (CV) benefits of high-density lipoprotein cholesterol (HDL-C) and the potential for adverse outcomes with extremely high levels.

OBJECTIVE

We conducted a meta-analysis to investigate the association between very high HDL-C levels (≥80 mg/dL) and mortality outcomes in individuals without coronary artery disease (CAD).

METHODS

We systematically searched PubMed, Embase, and Cochrane databases for studies comparing very high HDL-C levels to normal levels (40–60 mg/dL) in CAD-free individuals. We assessed heterogeneity using I² statistics with a random-effects model.

RESULTS

Our analysis included 1,004,584 individuals from 8 studies, of whom 133,646 (13.3%) had very high HDL-C levels. All-cause mortality did not significantly differ between groups (p = 0.55), nor did cancer mortality (p = 0.45). Cardiovascular mortality showed no change in those with very high HDL-C (hazard ratio [HR] 1.05; 95% confidence interval [CI] 0.94–1.17; p = 0.37). Fatal and non-fatal coronary heart disease events were less frequent in the very high HDL-C group (HR 0.79; 95% CI 0.73–0.86; p < 0.00001). Subgroup dose-response analysis revealed that very high HDL-C levels increased cardiovascular death in women above 116 mg/dL (HR 1.47; 95% CI 1.01–2.15) and in men above 94 mg/dL (HR 1.29; 95% CI 1.01–1.65) (p_nonlinearity <0.01).

CONCLUSIONS

These findings suggest that very high HDL-C levels are not protective against CV mortality and may, in fact, increase CV mortality risk especially in men.

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极高 HDL-C 水平与死亡率之间的关系：系统回顾与元分析

背景最近的研究对高密度脂蛋白胆固醇（HDL-C）假定的心血管（CV）益处以及极高水平的高密度脂蛋白胆固醇可能导致的不良后果提出了质疑。目的我们进行了一项荟萃分析，以研究超高 HDL-C 水平（≥80 mg/dL）与无冠状动脉疾病（CAD）患者的死亡率之间的关系。方法我们系统地检索了 PubMed、Embase 和 Cochrane 数据库中关于无 CAD 患者中超高 HDL-C 水平与正常水平（40-60 mg/dL）的比较研究。我们使用随机效应模型的 I2 统计量评估了异质性。结果我们的分析纳入了来自 8 项研究的 1,004,584 人，其中 133,646 人（13.3%）的 HDL-C 水平非常高。不同组别的全因死亡率（p = 0.55）和癌症死亡率（p = 0.45）没有明显差异。心血管疾病死亡率在高密度脂蛋白胆固醇水平很高的人群中没有变化（危险比 [HR] 1.05；95% 置信区间 [CI] 0.94-1.17；p = 0.37）。高 HDL-C 组的致命和非致命冠心病事件发生率较低（HR 0.79；95% CI 0.73-0.86；p <；0.00001）。亚组剂量-反应分析表明，HDL-C水平很高的女性心血管疾病死亡率高于116 mg/dL（HR 1.47；95% CI 1.01-2.15），男性高于94 mg/dL（HR 1.29；95% CI 1.01-1.65）（p_非线性<0.01）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of clinical lipidology 医学-药学

CiteScore

7.00

自引率

6.80%

发文量

209

审稿时长

49 days

期刊介绍： Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. While preference is given to material of immediate practical concern, the science that underpins lipidology is forwarded by expert contributors so that evidence-based approaches to reducing cardiovascular and coronary heart disease can be made immediately available to our readers. Sections of the Journal will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.