The U-Shaped Association of Non-High-Density Lipoprotein Cholesterol Levels With All-Cause and Cardiovascular Mortality Among Patients With Hypertension

Background: Non-high-density lipoprotein cholesterol (non-HDL-C) is a valuable indicator in routine blood lipid tests, but the associations of non-HDL-C with mortality in hypertensive population still remain uncertain.Methods: In the National Health and Nutrition Examination Surveys from 1999 to 2014, participants having hypertension were included and grouped by non-HDL-C levels (<130, 130–159, 160–189, 190–219, and ≥220 mg/dl). Multivariate Cox regression was conducted for calculation of hazard ratios (HR) and 95% confidence interval (CI). To reveal the relationship between non-HDL-C and mortality, Kaplan–Meier survival curves, restricted cubic spline, linear regression, and subgroup analysis were also applied.Results: A total of 12,169 participants (47.52% males, mean age 57.27 ± 15.79 years) were included. During average follow-up of 92.5 months, 1,946 (15.99%) all-cause deaths and 422 (3.47%) cardiovascular deaths occurred. After adjusting for confounders, the association of non-HDL-C with mortality was detected as U-shaped. Threshold values were observed at 158 mg/dl for all-cause mortality and 190 mg/dl as to cardiovascular mortality. Below the threshold, every 10 mg/dl increment in non-HDL-C attributed to relatively low all-cause mortality significantly (HR = 0.94, 95% CI: 0.92–0.96). Above the threshold, non-HDL-C has significant positive associations with both all-cause (HR = 1.03, 95% CI: 1.01–1.05) and cardiovascular mortality (HR = 1.09, 95% CI: 1.05–1.14). For subgroups analysis, similar results were found among participants age <65 years old, non-white population, those were not taking lipid-lowering drugs, and subjects with body mass index (BMI) ≥25 kg/m2.Conclusion: The U-shaped association was detected between non-HDL-C and mortality among hypertensive population.

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Effects of high-density lipoprotein targeting treatments on cardiovascular outcomes: A systematic review and meta-analysis

European Journal of Preventive Cardiology ◽

10.1177/2047487318816495 ◽

2018 ◽

Vol 26 (5) ◽

pp. 533-543 ◽

Cited By ~ 10

Author(s):

Haris Riaz ◽

Safi U Khan ◽

Hammad Rahman ◽

Nishant P Shah ◽

Edo Kaluski ◽

...

Keyword(s):

Myocardial Infarction ◽

High Density Lipoprotein ◽

High Density Lipoprotein Cholesterol ◽

Cardiovascular Mortality ◽

Meta Analysis ◽

Density Lipoprotein ◽

Cardiovascular Outcomes ◽

High Density ◽

Lipoprotein Cholesterol ◽

All Cause Mortality

Background The effects of increasing high-density lipoprotein cholesterol on cardiovascular outcomes remain uncertain. Design We conducted a meta-analysis to investigate the effects of high-density lipoprotein cholesterol modifiers (niacin, fibrates and cholesteryl ester transfer protein inhibitors) on cardiovascular outcomes. Methods Thirty-one randomized controlled trials (154,601 patients) with a follow-up of 6 months or more and a sample size of 100 or more patients were selected using MEDLINE, EMBASE and CENTRAL database (inception January 2018). Results High-density lipoprotein cholesterol modifiers had no statistically significant effect on cardiovascular mortality in terms of relative risk (RR) (RR 0.94, 95% confidence interval (CI) 0.89–1.00, P = 0.05, I2 = 13%) or absolute risk (risk difference −0.0001, 95% CI −0.0014, 0.0011, P = 0.84, I2 = 28%). High-density lipoprotein cholesterol modifiers reduced the RR of myocardial infarction (RR 0.87, 95% CI 0.82–0.93, P < 0.001, I2 = 37%). This significant effect was derived by the use of fibrates (RR 0.80, 95% CI 0.73–0.87, P < 0.001, I2 = 22%) and meta-regression analysis showed that this benefit was consistent with an absolute reduction in low-density lipoprotein cholesterol. High-density lipoprotein cholesterol modifiers had no effect on stroke (RR 1.00, 95% CI 0.93–1.09, P = 0.94, I2 = 25%) or all-cause mortality (RR 1.02, 95% CI 0.97–1.08, P = 0.48, I2 = 49%). Meta-regression analyses failed to demonstrate a significant association of pharmacologically increased high-density lipoprotein cholesterol with key endpoints. In studies with background statin therapy, high-density lipoprotein cholesterol modifiers had no statistically significant impact on cardiovascular mortality, myocardial infarction, stroke or all-cause mortality ( P > 0.05). Conclusion The use of high-density lipoprotein cholesterol modifying treatments had no significant effect on cardiovascular mortality, stroke or all-cause mortality. The beneficial effect on myocardial infarction was lost when drugs were used with statin therapy.

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U-Shaped Association of High-Density Lipoprotein Cholesterol with All-Cause and Cardiovascular Mortality in Hypertensive Population

Risk Management and Healthcare Policy ◽

10.2147/rmhp.s272624 ◽

2020 ◽

Vol Volume 13 ◽

pp. 2013-2025

Author(s):

Chao-lei Chen ◽

Xiaocong Liu ◽

Lin Liu ◽

Kenneth Lo ◽

Yuling Yu ◽

...

Keyword(s):

High Density Lipoprotein ◽

High Density Lipoprotein Cholesterol ◽

Cardiovascular Mortality ◽

Density Lipoprotein ◽

High Density ◽

Lipoprotein Cholesterol ◽

Hypertensive Population

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Contribution of Nontraditional Lipid Profiles to Hyperuricemia in a Hypertensive Population: Findings from the China Hypertension Registry Study

10.21203/rs.3.rs-92273/v1 ◽

2020 ◽

Author(s):

Yu Yu ◽

Wangsheng Fang ◽

Dandan Wang ◽

Yu Tao ◽

Minghui Li ◽

...

Keyword(s):

High Density Lipoprotein ◽

High Density Lipoprotein Cholesterol ◽

Multivariate Logistic Regression Analysis ◽

Density Lipoprotein ◽

Lipid Profiles ◽

High Density ◽

Lipoprotein Cholesterol ◽

Lipid Lowering ◽

Hypertensive Population ◽

The Relationship

Abstract Background: Current studies support nontraditional lipid profiles [total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C) ratio, triglyceride (TG)/HDL-C ratio, low-density lipoprotein cholesterol (LDL -C)/HDL-C ratio, non-high-density lipoprotein cholesterol (non-HDL-C)] as reliable indicators of cardiovascular disease, stroke and diabetes. However, whether nontraditional lipid profiles can be used as reliable markers for hyperuricemia (HUA) remains unclear due to limited research. The present study investigated the relationship of nontraditional lipid profiles with HUA in hypertensive patients.Methods: We analyzed data from 13,721 Chinese hypertensive population untreated with lipid-lowering drugs. The relationship between non-traditional lipid profiles and HUA was examined by multivariate logistic regression analysis and smooth curve fitting (penalized spline method).Results: The results showed that there were positive associations of TC/HDL-C ratio, TG/HDL-C ratio, LDL-C/HDL-C ratio, and non-HDL-C with HUA, respectively (all P <0.001). Furthermore, nontraditional lipid profiles were converted from continuous variables to tertiles. Compared with lowest tertile, the multivariate adjusted ORs (95% CI) of TC/HDL-C ratio, TG/HDL-C ratio, LDL-C/HDL-C ratio and non-HDL-C in highest tertile were 1.79 (1.62, 1.99), 2.09 (1.88, 2.32), 1.67 (1.51, 1.86), 1.93 (1.74, 2.13), respectively (all P <0.001).Conclusions: In Chinese hypertensive population, there were positive associations between nontraditional lipid profiles (TC/HDL-C ratio, TG/HDL-C ratio, LDL-C/HDL-C ratio, and non-HDL-C) and HUA. Our findings further expand the scope of application of nontraditional lipid profiles. These novel and important results suggest that nontraditional lipid profiles can be used as potential and valuable indicators of HUA, and provide a new strategy for the prevention and treatment of HUA.

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Triglyceride to high density lipoprotein cholesterol ratio, total cholesterol to high density lipoprotein cholesterol ratio and low ankle brachial index in an elderly population

VASA ◽

10.1024/0301-1526/a000348 ◽

2014 ◽

Vol 43 (3) ◽

pp. 189-197 ◽

Cited By ~ 10

Author(s):

Yiqiang Zhan ◽

Jinming Yu ◽

Rongjing Ding ◽

Yihong Sun ◽

Dayi Hu

Keyword(s):

High Density Lipoprotein ◽

Total Cholesterol ◽

High Density Lipoprotein Cholesterol ◽

Ankle Brachial Index ◽

Density Lipoprotein ◽

High Density ◽

Lipoprotein Cholesterol ◽

Lipid Lowering ◽

Cholesterol Ratio ◽

Potential Biomarker

Background: The associations of triglyceride (TG) to high-density lipoprotein cholesterol ratio (HDL‑C) and total cholesterol (TC) to HDL‑C ratio and low ankle brachial index (ABI) were seldom investigated. Patients and methods: A population based cross-sectional survey was conducted and 2982 participants 60 years and over were recruited. TG, TC, HDL‑C, and low-density lipoprotein cholesterol (LDL-C) were assessed in all participants. Low ABI was defined as ABI ≤ 0.9 in either leg. Multiple logistic regression models were applied to study the association between TG/HDL‑C ratio, TC/HDL‑C ratio and low ABI. Results: The TG/HDL‑C ratios for those with ABI > 0.9 and ABI ≤ 0.9 were 1.28 ± 1.20 and 1.48 ± 1.13 (P < 0.0001), while the TC/HDL‑C ratios were 3.96 ± 1.09 and 4.32 ± 1.15 (P < 0.0001), respectively. After adjusting for age, gender, body mass index, obesity, current drinking, physical activity, hypertension, diabetes, lipid-lowering drugs, and cardiovascular disease history, the odds ratios (ORs) with 95 % confidence intervals (CIs) of low ABI for TG/HDL‑C ratio and TC/HDL‑C ratio were 1.10 (0.96, 1.26) and 1.34 (1.14, 1.59) in non-smokers. When TC was further adjusted, the ORs (95 % CIs) were 1.40 (0.79, 2.52) and 1.53 (1.21, 1.93) for TG/HDL‑C ratio and TC/HDL‑C ratio, respectively. Non-linear relationships were detected between TG/HDL‑C ratio and TC/HDL‑C ratio and low ABI in both smokers and non-smokers. Conclusions: TC/HDL‑C ratio was significantly associated with low ABI in non-smokers and the association was independent of TC, TG, HDL‑C, and LDL-C. TC/HDL‑C might be considered as a potential biomarker for early peripheral arterial disease screening.

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Patterns and trends of potentially inappropriate high-density lipoprotein cholesterol testing in Australian adults at high risk of cardiovascular disease from 2008 to 2014: analysis of linked individual patient data from the Australian Medicare Benefits Schedule and Pharmaceutical Benefits Scheme

BMJ Open ◽

10.1136/bmjopen-2017-019041 ◽

2018 ◽

Vol 8 (3) ◽

pp. e019041 ◽

Cited By ~ 4

Author(s):

Farshid Hajati ◽

Evan Atlantis ◽

Katy J L Bell ◽

Federico Girosi

Keyword(s):

Cardiovascular Disease ◽

High Risk ◽

High Density Lipoprotein ◽

High Density Lipoprotein Cholesterol ◽

Density Lipoprotein ◽

High Density ◽

Lipoprotein Cholesterol ◽

Lipid Lowering ◽

National Guidelines ◽

Pharmaceutical Benefits Scheme

ObjectivesWe examine the extent to which the adult Australian population on lipid-lowering medications receives the level of high-density lipoprotein cholesterol (HDL-C) testing recommended by national guidelines.DataWe analysed records from 7 years (2008–2014) of the 10% publicly available sample of deidentified, individual level, linked Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) electronic databases of Australia.MethodsThe PBS data were used to identify individuals on stable prescriptions of lipid-lowering treatment. The MBS data were used to estimate the annual frequency of HDL-C testing. We developed a methodology to address the issue of ‘episode coning’ in the MBS data, which causes an undercounting of pathology tests. We used a published figure on the proportion of unreported HDL-C tests to correct for the undercounting and estimate the probability that an HDL-C test was performed. We judged appropriateness of testing frequency by comparing the HDL-C testing rate to guidelines’ recommendations of annual testing for people at high risk for cardiovascular disease.ResultsWe estimated that approximately 49% of the population on stable lipid-lowering treatment did not receive any HDL-C test in a given year. We also found that approximately 19% of the same population received two or more HDL-C tests within the year. These levels of underutilisation and overutilisation have been changing at an average rate of 2% and −4% a year, respectively, since 2009. The yearly expenditure associated with test overutilisation was approximately $A4.3 million during the study period, while the cost averted because of test underutilisation was approximately $A11.3 million a year.ConclusionsWe found that approximately half of Australians on stable lipid-lowering treatment may be having fewer HDL-C testing than recommended by national guidelines, while nearly one-fifth are having more tests than recommended.

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