Preventive Cardiology
Relation of Black Race Between High Density Lipoprotein Cholesterol Content, High Density Lipoprotein Particles and Coronary Events (from the Dallas Heart Study)

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Therapies targeting high-density lipoprotein cholesterol content (HDL-C) have not improved coronary heart disease (CHD) outcomes. High-density lipoprotein particle concentration (HDL-P) may better predict CHD. However, the impact of race/ethnicity on the relations between HDL-P and subclinical atherosclerosis and incident CHD events has not been described. Participants from the Dallas Heart Study (DHS), a multiethnic, probability-based, population cohort of Dallas County adults, underwent the following baseline measurements: HDL-C, HDL-P by nuclear magnetic resonance imaging, and coronary artery calcium by electron-beam computed tomography. Participants were followed for a median of 9.3 years for incident CHD events (composite of first myocardial infarction, stroke, coronary revascularization, or cardiovascular death). The study comprised 1,977 participants free of CHD (51% women, 46% black). In adjusted models, HDL-C was not associated with prevalent coronary artery calcium (p = 0.13) or incident CHD overall (hazard ratio [HR] per 1 SD 0.89, 95% confidence interval [CI] 0.76 to 1.05). However, HDL-C was inversely associated with incident CHD among nonblack (adjusted HR per 1 SD 0.67, 95% CI 0.46 to 0.97) but not black participants (HR 0.94, 95% CI 0.78 to 1.13, pinteraction = 0.05). Conversely, HDL-P, adjusted for risk factors and HDL-C, was inversely associated with prevalent coronary artery calcium (p = 0.009) and with incident CHD overall (adjusted HR per 1 SD 0.73, 95% CI 0.62 to 0.86), with no interaction by black race/ethnicity (pinteraction = 0.57). In conclusion, in contrast to HDL-C, the inverse relation between HDL-P and incident CHD events is consistent across ethnicities. These findings suggest that HDL-P is superior to HDL-C in predicting prevalent atherosclerosis as well as incident CHD events across a diverse population and should be considered as a therapeutic target.

Section snippets

Methods

The Dallas Heart Study (DHS) is a multiethnic, probability-based, population cohort study of Dallas County residents, with deliberate oversampling of black participants. The study design has been extensively described previously.3 Briefly, from 2000 to 2002, 2,971 participants completed a detailed in-home survey, laboratory testing, and imaging studies. For the present study, the study population comprised 1,977 participants who, at study entry, were not taking any lipid-lowering medications or

Results

The study comprised 1,977 adult participants; 51% were women, and 46% were black. Among men, blacks had highest median HDL-C and HDL-P and the largest median HDL particle size (Table 1). However, the magnitudes of the differences in median HDL-P (2%) and HDL particle size (3%) were smaller than those for HDL-C (17%). Among women, white women had the highest median HDL-C and HDL-P (Table 1). Unlike black men, black women had discordant HDL composition compared with white women (similar median

Discussion

In a large multiethnic, population-based cohort, we describe for the first time that factors that associate with levels of HDL-P, a novel marker of HDL composition, vary significantly from those that associate with HDL-C in an ethnicity- and gender-specific manner. This is also the first report to show that HDL-P is inversely associated with prevalent coronary calcium in the general population. In addition, we demonstrate that black ethnicity modifies the association between HDL-C and incident

Disclosures

Dr. McGuire has received consulting income from F. Hoffmann LaRoche, Genentech, Sanofi-Aventis, Daiichi Sankyo, Novo Nordisk, and Tethys Bioscience. Dr. Rohatgi has received grant support from Merck and is on the speaker’s bureau of AstraZeneca.

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Cited by (34)

  • Race-Dependent Association of High-Density Lipoprotein Cholesterol Levels With Incident Coronary Artery Disease

    2022, Journal of the American College of Cardiology
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    Most evidence stems from ethnically White-enriched cohorts; therefore, it is unknown whether the U-shaped association applies to all races and ethnicities. In the Dallas Heart Study, with 46% Black participants, HDL-C was inversely associated with incident CHD among non-Black but not in Black participants.25 A prior analysis in a cancer-focused REGARDS substudy did report that HDL-C of 30 to 40 mg/dL—compared with HDL-C >40 mg/dL—was associated with lower CHD risk in Black but not in White adults, but did not report on the association of all established HDL-C clinical categories with CHD risk.26

  • Cholesterol efflux capacity, HDL cholesterol, and risk of coronary heart disease: A nested case-control study in men

    2019, Journal of Lipid Research
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    Some recent studies conducted among prospective cohorts free of underlying CVD have reported strong inverse associations between CEC and cardiovascular events even with adjustment for HDL-C (14, 15, 30). For example, in an analysis of the Dallas Heart Study with black participants comprising 49% of the population, Rohatgi et al. (15) reported a 67% lower risk of a mixed cardiovascular endpoint in the highest versus lowest quartile of CEC (0.33; 0.19–0.55), adjusted for HDL-C. Interestingly, HDL-C itself was not strongly inversely associated with risk of CHD in the Dallas Heart Study (15, 31). The strength of HDL-C as a risk factor for CHD has been questioned in individuals of African American descent (31), which may offer a partial explanation for the discrepancy in findings between the Dallas Heart Study CEC analysis and the present study.

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The Dallas Heart Study was funded by the Donald W. Reynolds Foundation and was partially supported by the National Center for Advancing Translational Sciences of the National Institutes of Health, Bethesda, Maryland, under Award Number UL1TR001105. Dr. Rohatgi is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number K08HL118131. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the National Heart, Lung, and Blood Institute.

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